Integrated skills for parenting the adolescents ( ISPA ) : An intervention to strengthen parent-adolescent relationship

Las destrezas o habilidades parentales son un aspecto importante del desarrollo infantil. El adiestramiento de los padres en la adquisicion y cultivo de estas destrezas es un proceso reciente orientado a su capacitacion apropiada en el manejo del nino dentro de su cultura y su comunidad utilizando principios didacticos especificos para tal cultura. En la India han comenzado a emerger una serie de presentaciones sistematicas de modelos basados en evidencias en el desarrollo de habilidades parentales. El presente articulo describe uno de estos programas (Habilidades Integrales para padres de adolescents, ISPA, sigla en ingles) orientado al reforzamiento del vinculo padre-adolescente y a la descripcion de sus componentes. Luego de una evaluacion inicial de las necesidades de los padres de ninos adolescents, 13 padres siguieron sistematicamente el programa de once sesiones, cada una de ellas enfocando temas diferentes.Los resultados antes y despues de la intervencion muestran cambios estadisticamente significativos en las actitudes de los padres respecto a una relacion positiva con sus hijos adolescentes. Se describen los “pros y contras” de tales enfoques.


RESUMEN
Las destrezas o habilidades parentales son un aspecto importante del desarrollo infantil.El adiestramiento de los padres en la adquisición y cultivo de estas destrezas es un proceso reciente orientado a su capacitación apropiada en el manejo del niño dentro de su cultura y su comunidad utilizando principios didácticos específicos para tal cultura.En la India han comenzado a emerger una serie de presentaciones sistemáticas de modelos basados en evidencias en el desarrollo de habilidades parentales.El presente artículo describe uno de estos programas (Habilidades Integrales para padres de adolescents, ISPA, sigla en ingles) orientado al reforzamiento del vínculo padre-adolescente y a la descripción de sus componentes.Luego de una evaluación inicial de las necesidades de los padres de niños adolescents, 13 padres siguieron sistemáticamente el programa de once sesiones, cada una de ellas enfocando temas diferentes.Los resultados antes y después de la intervención muestran cambios estadísticamente significativos en las actitudes de los padres respecto a una relación positiva con sus hijos adolescentes.Se describen los "pros y contras" de tales enfoques.

INTRODUCTION
Parenting is one of the major skills which influence the development of the child but often across cultures parents are expected to pick up these skills by themselves.These skills are universally accepted roles of adults within families.It is both a commitment and a responsibility towards bringing up children.Parenting as an outcome-driven activity is no more just a pleasurable doing alone, something from which a parent derives happiness and fulfillment.It includes a variety of day-to-day interactions which have the potential to deplete one's energy, and cause strain and stress in parent-child relationship as well as between the two parents and across other family members.Especially with adolescent children, parents go through a mixed emotional, cognitive and behavioral struggle.Adolescence's years are often seen as the most stressful for the teenagers as well as their parents.This bond between parents and children has several reciprocal dynamics through which they try to meet each other's needs.When these needs are unmet, parents go through experiences of frustration, anger, and sadness which, in turn are reflected in inflexible attitudes and behaviors, inability to think positive about the teenager or rather, become more parentcentric.Such struggle in the parent-child relationship causes a lack of intimacy and conflicts between parents and teenagers (1,2).With the monumental changes in life styles and social behaviors, parents, have to deal with not only the normal problems and crises of adolescent development, but also face a complex set of expectations that make parenting even more difficult and stressful (3).
Parenting practices are emerging as a matter of serious concern and have become an important aspect of a public mental health agenda for mental health professionals as well as for teachers and parents themselves.In cultures such as India, which are in transition, emerging from traditional models towards a more modern one there are additional challenges.The family structures are changing from joint and kinshipbased systems to a more nuclear family which brings with it challenges in bringing up children with limited family support especially if both parents are working.Increasing reporting by the media across India on stories of negligence by parents or their cruelty towards children is making the need for training parents an urgent issue.Often, parental behaviors are brought to wider scrutiny only in such extreme cases when the rest of the society questions their impacts on children.

Need for parental training
Teenage years are one of the most exciting times of youngsters' lives but can be a difficult period for them and their parents.This is a time when teenagers question their parents, ask for freedom and more time with friends as they try to individuate themselves, become more argumentative and develop their own ways of thinking and problem-solving.Though these situations are part of the normal course of growing up, parents may find it difficult to deal with in the dayto-day affairs.These difficulties, in turn, make the interactions more stressful and confrontational.Not every parent possesses all the skills and knowledge needed to handle every issue of the teenager's development.Some parents may possess skills but may not be able to use them effectively, while others do not have skills to deal with the specific issues of adolescents.However, most would agree to the fact that the intentions of parents remain genuine (4).
Generation gap, a period of time that entails opposing ideologies of parents and children, is found to be simultaneously growing up as individuals in families grow up.Throughout the passage of time, the new ideas and practices, brought by the children from outside the families as they are keen to establish themselves, may be opposed by the parents who may be holding on to traditional beliefs.Eventually, frictions are seen in the ideologies of both parties when behaviors and questions of children do not match with the 'good behavior' framework set up and expected by the parents for them.Parents and children perceive this particular gap correctly.Unfortunately, making a compromise is often difficult because of the magnitude of its influence on each other, thereby leading to ideological conflicts, which then become exaggerated and manifest themselves in the escalation of those conflicts.
Parenting as a function as well as an expected role is a stressful activity (1).Parents are often involved in multiple activities related to themselves, their jobs, family affairs and other associated institutions, in addition to those concerned with their children.The teenagers are exposed to a number of possibilities outside their homes.Peer pressure, exposure to media, newer technologies such as social media and their own personality characteristics will play a role in varying degrees leading to concerns and worries in parents.These concerns needs to be understood as real, and must be dealt with efficiently to help parents see children from their point of view too.

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There are several factors responsible for making parenting experiences challenging.These include a lack of awareness about the developmental needs of children, inability to handle issues of children in ways appropriate to their age, reduced confidence, a feeling of inadequacy as parents, parental stress, lack of involvement by fathers (5), and differences in parental behaviors related to gender of the child (6).
Help to develop parenting skills has produced systematic models of practice especially in the West, aimed atassisting parents to deal with children with specific psychosocial concerns, or parents with difficulties in child rearing practices (3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).Internet sources, schools and parent-teacher associations, books and magazines are available sources of support.These prescribe do's and don'ts in parenting practices for those who need them.
It is important to bear in mind that cultural factors play a major role in accessing these skills.In India for example, parents are sometimes hesitant to take parenting skills training because they are often afraid that this new learning may undermine their efforts and highlight failures in upbringing, thereby stigmatizing them.This failure in upbringing may be seen as a very embarrassing situation for parents, so they may not consider the need for such training.The scenario has started to change but accepting help from professionals in the matters of parenting is not very popular; this, in spite of studies showing that the impact of poor parenting on children can lead to both parents and children becoming unhappy and disturbed, therefore influencing expectations on both sides (2,4,19).Some of the major issues reported in families of adolescents are inconsistent parenting practices, high expectations from children, disobedience, and poor communication.Indian parents seem to emphasize academic achievement over any other achievements.Like parents elsewhere, they may invest their own ambitions into their children thereby becoming an extended person in the family to achieve parental expectations.Youngsters in India report that their parents show undue involvement in deciding their relationships, and hold rigid beliefs on marriage for their children at a time in which the overall cultural environment is changing (20).

The Indian Scene
Couples and young adults rely on their inherent capacity to be a parent from the experiences of being a child, or observing others involved in parenting-related activities.One of the most stressful and yet relevant roles a human may undertake has no formal training or programs to enhance those capacities.These beliefs in one's own abilities only get questioned if either the child or parents are affected due to the reciprocal impact of this role.In common with many other cultures, Indian parents get blamed when children misbehave or when things go wrong.Then and only sometimes, parents are held responsible for the effectiveness of parental investments.Often parents try to search for answers within themselves, with their families or kinship, social media, Internet or as a last resort with professionals who may or may not be trained in specific issues of parenting.As with many other things, there are a huge number of tips for "effective parenting" on the Internet but with very poor evidence base.In kinship-based societies, every individual contributes to parenting and will thus have strong views.Also, parents may resort to scriptures and ancient texts to learn about parenting.
The need for an empirical model for this matter in the Indian context is essential as it is in all kinds of culture which change as a result of industrialization, urbanization and globalization.Increased exposure to larger world, global influence on children about relationships, and growing individualistic concerns, cause parents to struggle in order to keep the children connected with families (20).In these situations' context, it has become necessary to promote the idea of resourceful parenting.
Difficulties between parents and their children are also related to the teenagers' schooling and school friendships, life outside home, poorer quality of relationship between parents and teenagers (21)(22)(23)(24), a lack of parental involvement in teenagers' life (25), lack of confidence in parents (26) and too strong an influence of the media (2) .As Davitz (3) and Huxely (1) have pointed out these days parenting itself has become a stressful activity, and parenting teenagers is a lot tougher than it was earlier.In cultures-intransition such as India there are not many studies exploring these issues especially dealing with support, coping and strength of parent-adolescent relationships.Support for parents of teenagers has received much less attention than for parents of younger children (27).
This study was set up to explore some of these issues but especially to check the possibility of delivering such training and education on parenting skills to the parents of adolescents.
Integrated skills for parenting the adolescents (ISPA): An intervention to strengthen parent-adolescent relationship.

Our parenting skills training program was based on
existing literature as well as on experts' knowledge.The major components included in the current program have also been used in others.Those included in the current study but which were not so much found in other programs included developing life skills, providing available information on support services, healthy study habits, dating practices, developing adolescent qualities like self-correction, self-control, self-contentment, pious character, freedom from prejudices, skillful use of a combined soft and firm love, healthy family interaction, and a detailed session on parent stress management.All these programs had positive outcomes in terms of greater improvement in family climate when both parents attend, changes in the attitudes of parents, improvement in child behavior, effective parenting responses, recommendations to friends, behavior control of children/ teenagers, and more understanding of the child/ teenager (28).
Additional outcome accomplishments include involving or engaging adolescents (7), emotional control communication, sense of humor, management skills, problem solving (8, 9), consistency (9), talking to teens about risks, monitoring teens' behavior, being a role model (10,29), understanding teenagers (3,11), developing trust, listening, understanding, reinforcement, setting limits, enhancing self esteem using the child's potentials, making close relationship with teenagers (3), increasing parents' self confidence, giving responsibility to teens, (12), sexuality education and promoting healthy sexual development (13), adolescent development (14), understanding one's own negative emotions and converting them into positive ones, relaxation, stress management for parents (15), flexibility, negotiation (16), developing self concept and self esteem (12,17), sibling relationship (Hindu scriptures), and parents as companion (30).Methodologies used for current study have been shown to be useful in other such programs.There were didactic and participant interactive methods of presentation, teaching, sharing of experience, parents' sharing of adolescents' behaviors, role plays, using techniques like reflections and reframing (14), educating parents on building their confidence (31), use of print and video materials, modeling, rehearsals, practice, feedback and goal setting (32).The Oregon Social Learning Centre (27,28) used different methodologies such as reading and teaching texts for its skills development program.Descriptive research design was used to explore and understand various needs of parents in the first phase.Parental couples and their teenage children who attended school in the age group of 12-16 from the city of Bangalore (a metropolitan Indian city) were informed about the study and later approached by the first author (BT) when asked to address parenting related issues in several Parent and Teachers Association (PTA) school meetings.Initial interest was expressed by 100 parents but for various reasons, largely related to time commitment and perceived stigma related to the topic, 36 participants dropped out and 4 were excluded from the study as their children had diagnosable psychiatric issues.Sixty couples and their teenagers filled up the questionnaires.The researcher met the parents at their convenience either in their homes or at school premises.
The majority (80%) of the parents were recruited from the meeting of the PTA in a school which had a range of diverse cultures (mostly from southern and Northern parts of India).47.6% mothers and 50% of fathers were college graduates.43.3 % were Christians, and 51.7% Hindus.The remaining 20% of parents and teenagers were recruited from a local public school with a higher socio-economic status.All of them received information about the basic principles of the research project.
The Child Behavior Questionnaire (CBQ) (33) was employed to screen the teenagers for inclusion in the study.Those who scored less than the cut-off were excluded as were their parents.The authors were interested in measuring behavioral problems which could be reascertained following specific interventions.In order to get a complete view about the various needs of parents, an interview schedule was developed on the basis of a review of the literature and discussions with experts, followed by face validation as well as discussions with parents prior to the start of the study.The interview had both open and closeended questions in order to gather information on socio demographic details of parents, their understanding on parenting, their needs and roles (details are available from the first author).Case vignettes were used to explore parental practices with teenagers in specific situations (mostly difficult ones they had with other teenagers, academic under achievement, romantic affairs, seeking freedom, and rebelliousness) (4).In addition, a child rearing practice inventory (34) was used to gather information about the child rearing practices followed by parents.A family environment scale (35) was employed to measure this aspect of the adolescent's life.The Parenting Bonding Instrument (36) was used to understand the perception of teenagers on their parents' parental behaviors.
The data collected were analyzed using descriptive statistics, content analysis and thematic analysis to derive themes for developing a parenting skills program.

Needs assessment:
The interactions with parents in clinics and schools and the qualitative data collected have been previously described (4).Serious parents' concerns included their acknowledging that they did not possess adequate information about the growth and development aspects of adolescents, as well as concerns about child rearing and disciplining matters.The parents reported that these concerns were part of their personal features and their own experience of being inconsistent, laying too much focus on the academic performance of the child, comparison with siblings and peers, treating adolescents as instruments to achieve their own ambitions; inability to relate to adolescents as growing adults; giving too much Table 1.Schedule of the Integrated Skills for Parenting the Adolescents (ISPA).Parents felt unable to deal with teenagers when the latter were in difficult situations, i.e., being argumentative, performing poorly in studies, and seeking excessive freedom (4).Parental response to perceived unsuitable friends especially romantic attachments, which are still frowned upon in the Indian context, also emerged as a matter of concern.

Phase 2: Content and methodology of the training program
Based on results of the qualitative information phase and utilizing additional behavioral and instruction formulations, the specific interventions were arranged thematically.This intervention package --Integrated Skills for Parenting the Adolescents (ISPA)--was used to work with parents.A broad framework in the Parenting skills Training Package included the conceptual understanding of each practice skill, and practical techniques for use in the day-to-day interactions with their adolescents.The program was interactive with an emphasis on increasing parents' understanding on adolescence, enhancing parent-adolescent relationships, practical ways of strengthening positive interactions, and developing confidence, clarity of roles and parenting skills (Table1).
The process expected full parental involvement in a dynamic teaching and learning process.The training package included techniques like games, brain storming sessions, group sharing, group discussions, role-playing, simulation groups, short lectures, demonstrations, and homework assignments.The program was validated by three experts from family therapy practice.

Phase 3: Intervention phase
Following explanations of the intervention and contents, 15 parents agreed to participate.Only two sets of parents comprised of couples.Only two parents dropped out after 4 sessions.Thus the report presents findings from 13 parents.
The training program was conducted generally on a weekly basis, over a 2-month period.Training sessions were generally conducted in the evenings or over the weekend to facilitate participation.As illustrated in Table 1, a total of 11 sessions were conducted--one module for each of the ten parenting skills.At the end of each module, the participants were asked to provide feedback on the session.The final assessment tool --Post intervention Evaluation Form--was given to the participants at the end, after completion of the program.

Phase 4: Evaluation
Post-intervention assessments were carried out following the last session.Parents preferred to fill in the forms in their own time and they were given a week to return the forms.The assessment measures used for the post-intervention assessment were the same as those used prior to the intervention.

Statistical Tests
Descriptive statistics such as frequency, mean and standard deviation were used to analyze the socio demographic details and the distribution of samples.Inferential statistics like paired t test, chi square were used for hypothesis testing.Content analysis and frequency distribution were used to analyze the qualitative data collected during the intervention program.
Analysis of qualitative data was done manually.Quantitative analysis was done using SPSS 16.

Ethical approval
Ethical approval was obtained from the local committee.Parents and children gave written informed consent.Anonymity of the respondents and strict confidentiality were maintained.The results of the study were made available to the parents if they were interested.During the process of the study, parents and children who required further psychosocial care were referred to appropriate clinical services.At the request of the parents an additional one-day workshop on Life Skills was conducted for the teenagers.

Socio-demographic details
The participants in the parenting skills training program included 10 mothers and 3 fathers.6 of them were between 30-40 years old; 4 others were more than 50 years old and the remaining 3 were between 41-50 years.All of them belonged to the Hindu religion, and were from urban background.Ten of them were college graduates, most of them belonging to middle socio-economic status.The group consisted of 6 home makers, 3 teachers and 4 working in service sector.All the participants were living with their spouse and children.No marital discord was reported by any of them.

Parents' understanding on parenting, their roles and needs
Parents reported positive changes in their understanding about parenting following training, and this reached statistically significant levels (p<.01) suggesting that they were able to understand that parenting is not only about fulfilling the needs of adolescents, and that there are differences in the needs of children of different age groups.Parents' efforts in understanding teenagers increased, bringing office work to home was reduced, parents became approachable confidants of the teenagers.
The intervention also helped parents to realize the need for spending time with teenager (p<0.01),need for socializing, (p<0.01),seeking support from relatives (p<0.01),readiness to seek professional help when needed (p<0.05),feeling satisfied as a parent (p<0.05),having family rituals (p<0.01),and also in updating themselves about the challenges being faced by the adolescents (p<0.05).

Changes in practices and skills
The changes reported in the child rearing practices inventory were also statistically significant at .05 levels on paired t test.Mean scores in child rearing practices like overprotection, harsh parenting, ridicule and rejection were reduced, and those of normal and esteem-building child rearing practices increased.At the family interaction level, cohesion, expressiveness, recreational orientation, and intellectual orientation increased at p<0.05 level, and the conflict situations in the family decreased significantly (p<0.01).Following the intervention, the ability to handle specific problematic situations with the adolescents (rebelliousness, relationships, study habits, freedom and responsibility issues) did increase significantly.

Qualitative reports of post interventions changes in parents
Changes in self: A majority (61.5%) of the parents reported that they gained more confidence in their role, and became more patient than before.53.9% of them agreed that they became more flexible in their attitude, and better able to listen more to the teenagers.Better emotional control was gained by 38.5% of the parents.The reported changes led to being assertive, exhibit a better ability to negotiate with adolescents, better decision-making and problem-solving abilities; making oneself more approachable to the teenager and finding pleasure in being a parent were reported by 23.1% of the parents.Parents also reported changes in developing positive attitudes towards sexuality education, healthy life styles, being able to think more, not being overprotective, being more forgiving and tolerating a few deviances of teenagers, being able to forgive mistakes of others, and accepting one's own mistakes.They also reported being more open to the idea of children's dating, being able to manage time, being able to realize the change in one, and finding calm and at peace.

Changes in relation to the adolescents:
Most of the parents (76.9%) reported being able to accept the teenagers as they are.61.5% of parents felt better able to listen to their teenagers following the training program.More than half (53.9%) of the parents also became more encouraging, able to spend quality time and better communication with the teenagers.Nearly half (46.2%) reported better understanding of the teenagers.38.5% brought about changes in using a combination of reward and punishment, being more friendly with them, and help them solve their problems.Nearly one third (30.8%) were able to get reasonably involved in their teen's decision-making.A quarter (23.1%) reported that their ability to spend quality time with teenagers had improved, as had their ability to be less punitive and offer more freedom to them.Parents also helped teenagers to accept their failures, instilling confidence, and getting them involved in the family activities.

Changes in relation to other family members:
One third (23.1%) of the parents reported an improvement in their marital relationship and an ability to solve others' problems, and to interact more in and with the family.Additional changes included spending quality time with others, not comparing other family members, being able to communicate freely, ability to respond more than to react to other family members and, finally, being able to change one's behavior towards other family members in a positive direction.

Adolescents' perception on parental change
Seventy-three percent of them reported that their parents were better listeners.62.5% of them noted that Rev Neuropsiquiatr 76 (4), 2013.their parents were more patient and understanding.The adolescents also reported that their parents shouted less (37.5%), and quarelled less (12.5 %) with their spouses.

DISCUSSION
The changes reported after the intervention were similar to those found by other programs.Turner et al (32) reported that they found a great deal of change in the parents after an intervention of 8 sessions, that parents were highly satisfied and less reliant on a dysfunctional parenting practice.The Triple P program (18) was found to be very successful in that parents became better at acknowledging and encouraging the growing autonomy and independence of the teenagers, and were also more able to negotiate with the challenges and changes with the teenagers.Again, this was confirmed by our study, although we used a somewhat different program.
The Parent Time Programme by Cohen (28,37) also gave parents an enhanced capacity to listen, to set limits and to confide in other parents, another finding similar to our study's.Parents Who Care (38) reported that their program resulted in getting the parents involving adolescents in family decision-making and in recognizing their strengths.In a meta-analytic study, Kaminski (39) reported that parents had developed better child and adolescent development knowledge, care, positive interactions with child, responsiveness, sensitivity and nurturing, better disciplining methods, better problem-solving and promoting children's academic skills after participating in the parenting skills program.These observations are very similar to our findings indicating that parenting advice and training programs can bring about change.However it will be very interesting to explore how long these changes last.

Feasibility of a training program
Various components of the sessions such as time allotment, experiential sharing, provision of information, learning during the session, group discussions, presentation of each group, questions and answers, participants' cooperation, practicality of information and session as a whole were found to be useful and helpful by the participants.The total scores of all these aspects were highly acceptable, reaching over 75%.The lowest score was for the presentation of each group, which scored 77.6% and the highest score (95.4%) was obtained for the questions and clarifications aspects.All the aspects considered for the training sessions were highly adequate and useful.These observations indicate acceptability and feasibility of such an approach.
The actual contents of the sessions were highly rated, i.e., over 80%.The lowest score (81.8%) was obtained for the first session devoted to parental understanding of adolescence, and the highest (92.3%) was for the last session which discussed miscellaneous aspects such as sexuality, dating and healthy study habits.The scores revealed a high degree of satisfaction with the training program, on the part of the parents; we also used a roughly similar amount of time.The Oregon Social Learning Centre (27,28) used 20 hours for its entire program.We scheduled 11 sessions for a total of 20 hours, including the long time required for parents to discuss, interact, share, learn, practice, and rehearse the skills.The findings reported above reflect the suitability of the program even though the number of participants was small.Nevertheless, we can conclude that it is possible to carry out such training even in less developed countries and across cultures.More work is going on in rural settings to ascertain whether these approaches can be used.Our findings reveal that the content of the sessions for the training program were highly acceptable, highly rated and useful.The results of changes parents have brought in themselves and in relation to their teenagers, also throw light on the parents' potential to usetheir existing capacities and to learn new skills, thus making possible a healthy parent-adolescent relationship.Similar training on parenting skills can be provided to other groups or organizations, and use them to multiply the benefits without the need to increase the number of programs.

CONCLUSIONS
This study has future implications for public mental health and for working with families in order to minimize friction and enabling teenagers to develop skills in an appropriate manner.The method for training used here can be modified according to local requirements across different groups at different levels of educational and economic status.Larger samples may help evaluate actual contributions of specific components which can be a cost-effective way of developing further interventions.Since there are not many studies in the realm of parenting skills training in the Indian context, this program may constitute a baseline for comparison with future works.

Phase 1 :
This research was conceived to place such training in the Indian local cultural context, and was set up in two stages: Training needs assessment and actual intervention.Training needs assessment.