Parenting Interventions for Indigenous Child Psychosocial Functioning: A Scoping Review

Abstract

Objectives:

To scope evaluations of Indigenous parenting programs designed to improve child psychosocial outcomes.

Methods:

Electronic databases, gray literature, Indigenous websites and journals, and reference lists were searched. The search was restricted to high-income countries with a history of colonialism.

Results:

Sixteen studies describing evaluations of 13 programs were found. Most were controlled studies from United States and Australia, targeting child social, emotional, behavioral and mental health outcomes, and these were delivered to groups of parents. Program content focused most often on child development and learning, child behavior management, and parent–child interactions. Some studies reported improvements in child and parent outcomes, though the majority used self-report measures and some were noncontrolled studies.

Conclusions:

This scoping review provides the first known map of evaluations of programs targeting parents of Indigenous children. There were few rigorous evaluations of effectiveness. A rigorous systematic review is needed to evaluate the strength and extent of these findings.

Keywords

Indigenous Aboriginal parenting child psychosocial outcomes scoping review

Background

The impact of colonialism on the Indigenous people of Australia, New Zealand, the United States of America, and Canada has been significant and enduring. Since colonization, Indigenous people have been exposed to introduced diseases and suffered declines in their populations (Jones, 2006; Kunitz, 1996; Lange, 2011; Waldram, Herring, & Young, 2006) and faced dispossession of land and suppression and disruption of language and culture (National Collaborating Centre for Aboriginal Health, 2009-2010). Indigenous people have experienced trans-generational disruptions in family and community (Anderson, Baum, & Bentley, 2004; Brave Heart, 2003; Brave Heart & DeBruyn, 1998; Evans-Campbell, 2008) including generations of boarding and residential school placements (Blackstock, Trocmé, & Bennett, 2004; Kirmayer, Simpson, & Cargo, 2003; Robin, Rasmussen, & Gonzalez-Santin, 1999; Tait, 2003) and forced separations of children from families which for some populations, for example Aboriginal Australians in the mid-20th century, included governmental policy-driven kidnapping of children (Australian Human Rights Commission, 1997). Indigenous populations today face continuing socioeconomic disadvantage (Australian Institute of Health and Welfare, 2010), marginalization, and discrimination (Commonwealth of Australia, 1991; Currie, Wild, Schopflocher, Laing, & Vuegelers, 2012; Paradies & Cunningham, 2009; Priest, Paradies, Stewart, & Luke, 2011). In this article, the terms Indigenous and Aboriginal are used interchangeably and refer to the range of Aboriginal people living in countries that were colonized in earlier centuries.

The psychosocial functioning of Indigenous children has become an area of major concern as several high-income countries contend with the overrepresentation of Aboriginal children and families across a range of social service systems. In the United States, Canada, Australia, and New Zealand, Indigenous children are more likely to reside in out of home care than nonIndigenous children (Australian Institute of Health and Welfare, 2012; Children’s Bureau of the United States Department of Health and Human Services, 2010; Cornwall, 2004; Sinha et al., 2011). They are also more likely to be involved with juvenile justice (Australian Institute of Health and Welfare, 2011b; Brzozowski, Taylor-Butts, & Johnson, 2006; New Zealand Ministry of Justice, 2002; Snyder & Sickmund, 2006) and are disproportionately reported for child maltreatment (Australian Institute of Health and Welfare, 2012; Children’s Bureau of the United States Department of Health and Human Services, 2010; Mardani, 2010; Public Health Agency of Canada, 2010).

Indigenous children are also more likely to have lower educational attainment than non-Indigenous children (Australian Institute of Health and Welfare, 2011a; Mendelson, 2006; Ministry of Social Development, 2010; St. Germain & Dyck, 2011; Willetto & Goodluck, 2003; Zubrick, Silburn, & Lawrence, 2005), higher rates of teenage pregnancies (Australian Institute of Health and Welfare, 2011a; Statistics Canada, 2011; Willetto & Goodluck, 2003), higher rates of youth suicide (Beautrais & Fergusson, 2006; Borowsky, Resnick, Ireland, & Blum, 1999; Hunter & Harvey, 2003; Hunter & Milroy, 2006; Kirmayer, 1994; Kral, 2012; Lehti, Niemela, Hoven, Mandell, & Sourander, 2009) coupled with less access to health services (Australian Institute of Health and Welfare, 2008a, 2008b).

Service systems in colonialized countries attempt to respond to these disparities by increasing the amount of services delivered to families, however few programs are developed and evaluated for this group specifically. In the broader population, some of the most successful psychosocial interventions for children involve parent training (e.g., Triple P— de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008; Nowak & Heinrichs, 2008; Thomas & Zimmer-Gembeck, 2007). A number of systematic reviews have found parenting interventions to be effective in improving child (e.g., Barlow et al., 2011; Barlow, Smailagic, Ferriter, Bennett, & Jones, 2010; Eccleston, Palermo, Fisher, & Law, 2012; Furlong et al., 2012; Woolfenden, Williams, & Peat, 2009) and parent outcomes (e.g., Barlow et al., 2011; Barlow, Smailagic, Huband, Roloff, & Bennett, 2012; Eccleston et al., 2012; Furlong et al., 2012).

While interventions involving parents can vary considerably in nature, parenting programs are often construed as brief, manualized interventions lasting for up to 20 or 30 sessions (e.g., Barlow, Johnston, Kendrick, Polnay, & Stewart-Brown, 2008; Barlow et al., 2011). Programs involving parents and families can, however, extend for longer periods, such as in the case of home visiting programs (e.g., Olds, Henderson, & Kitzman, 1994). Parenting programs may be delivered in any setting, however the home or community are the frequently used environments. Delivery might be to groups of parents (e.g., Dean, Myors, & Evans, 2003), to parents on an individual basis (e.g., Morawska & Sanders, 2006), or it may involve a combination of these modes. Programs use a wide range of techniques in their delivery (Barlow et al., 2011) including discussion, modeling, coaching, rehearsal, written materials, didactic learning, and other approaches. The specific content of parenting programs depends on the purpose of the program, however parenting skills and information about managing child problems and improving child outcomes are common (e.g., positive parenting skills and content used in Triple P [www.triplep.net], Incredible Years [www.incredibleyears.com], and many other programs).

Although the concepts of “parent” and “family” are different in Indigenous cultures compared to non-Indigenous cultures (Borg & Paul, 2004; Farmer & Fasoli, 2010; Kruske, Belton, Wardaguga, & Narjic, 2012), the importance of parenting in promoting child outcomes is equally paramount. Specifically, involvement of parents/primary caregivers in interventions is key to promoting child well-being (Landry, Smith, Swank, Assel, & Vellet, 2001; Olds et al., 2007; Osofsky & Thompson, 2000), and this is true across cultures (Knerr, Gardner, & Cluver, 2013). While interventions to support Indigenous parents and families are conducted worldwide, the extent of their use, the nature of these interventions, or their effectiveness is unknown. Similarly, little is known about the effectiveness of implementing programs designed for non-Indigenous families within Indigenous communities.

While we acknowledge that there exist vast cultural and linguistic differences between Indigenous people, even within the same country, most share similar histories of oppression and resistance and struggle to maintain their respective cultures in the face of severe economic, social, and political challenges. These similar histories may be crucial for understanding and, ultimately, developing effective programs for these populations.

Purpose of this Review

There are no known published international scoping or systematic reviews that have specifically detailed or appraised programs for Indigenous children and families. In this study, we conducted a scoping review of programs targeting parents of Indigenous children in high-income countries with a history or colonization. According to Arksey and O’Malley (2005), scoping reviews can be used to map areas of study where little is known about the nature of the work. Research questions may not be as specific or well defined as in a systematic review (e.g., group-based parent-training programs for improving emotional and behavior adjustment in 0- to 3-year-old children [e.g., Barlow, Smailagic, Ferriter, Bennett, & Jones, 2010]). Further, scoping reviews typically aim to scope a large field of studies rather than those limited to specific study designs, such as including only controlled trials in systematic reviews. Unlike systematic reviews, scoping reviews rarely attempt to assess the quality of studies, and they may not even describe the findings of the included studies. Scoping reviews can be undertaken as a preliminary step to see what studies exist within a topic of interest in order to determine the feasibility or necessity of a systematic review, or a scoping review can be undertaken as a stand-alone review rather than part of a larger process. Like systematic reviews, scoping reviews require rigorous methodology and transparency of reporting (Arksey & O’Malley, 2005).

The purpose of this scoping exercise was to map evaluations of parenting programs for parents of Indigenous children. In undertaking this review, we aimed to determine the following:

Which countries, and cultural groups within them, have reported evaluating programs?

What types of programs or interventions have been provided?

How have they been evaluated?

What were the findings of the evaluations?

The article reported here pertains specifically to programs designed to improve child psychosocial outcomes, with a scoping review on programs targeting child health outcomes to follow. This scoping study summarizes the content, scope, and method of delivery of evaluated targeted parenting interventions for improving Indigenous child psychosocial outcomes and provides a picture of commonly used intervention methodologies and content in programs for Indigenous families.

Method

Search Strategy

Database searches

We searched six academic databases in 2011, namely, Medline (April 7); Journals@OVID (April 8), ERIC (April 8), CINAHL (April 12), PsycInfo (April 12), and The Cochrane Library (June 28). No limits were placed on database searches. All languages and years were included in the searches. Key words or identifiers were used as the search field with most databases. Where the fields were unavailable, abstracts was used as the search field.

The following search terms were used to find relevant studies, where * produces any form of the root word: (Aborigine* or Aboriginal* or Torres Strait Islander* or Maori* or American Indian* or Alask* Nativ* or Nativ* Alask* or Nativ* Hawaiian* or Hawaii* Nativ* or Nativ* Americ* or Americ* Nativ* or Americ* Samoa* or Samoa* Americ* or Eskimo* or Inuit* or Aleut* or Metis or First Nation* or Indigenous) and (family or families or familial or parent* or mother* or mom* or mum* or father* or dad* or kin or kith or grandpar* or grandmo* or grandfa* or aunt* or uncle* or cousin* or sibling* or Infant* or infancy or newborn* or baby* or babies or neonat* or preterm* or premature or postmatur* or child* or schoolchild* or school age* or preschool* or kid or kids or toddler* or adoles* or teen* or boy* or girl* or minors* or pubert* or pubescen* or prepubescen* or young people or young person* or youth* or failure to thrive or child physical abus* or child emotional abus* or child psychological abus* or child sexual abus* or child welfare or child maltreatment or foster care or fostercare or child abus* or child abuse prevention or child neglect) and (program* or intervention* or project* or treatment* or implement* or train* or strateg* or curricul* or measure* or tool* or assess* or instrument* or reliabilit* or validit* or validat* or psychometric* or model* or approach* or method* or practice* or evidence* or study* or studies* or therap*).

Consultant recommendations

At the same time as conducting the databases searches, we requested references that may be relevant to this review from our collaborators at Menzies School of Health in the Northern Territory, Australia.

Gray literature

We searched the following organizations’ websites for gray literature: Centers for Disease Control, Guide to Community Preventative Services, The Community Guide; Joanna Briggs Institute; National Health Service, National Institute for Health Research, Center for Reviews and Dissemination; University of Otago, Christchurch School of Medicine and Health Sciences, New Zealand Health Technology Assessment; National Institutes of Health, National Library of Medicine, Medline Plus; National Health Service, Evidence in Health and Social Care; OpenGrey, System for Information on Grey Literature in Europe; U.S. Department of Energy, Office of Scientific and Technical Information; National Institutes of Health, National Library of Medicine, Gateway; Online Computer Library Center, OCLC; British Library, Electronic Theses Online Service; Networked Digital Library of Theses and Dissertations; Canadian Evaluation Society; Europa, Gateway to the European Union; Government of Canada Publications; National Library of New Zealand; and Australian Government Publications

Where possible, we used the same search terms and fields as used in the database searches, using the websites’ search function, and imposing no limits. When the capacity of a website did not allow this, we reduced the number of search terms (e.g., reduced to Indigenous and parent).

Hand searches

Hand searches of the following Indigenous health and welfare websites were performed to find further published and unpublished literature: Australian Institute of Aboriginal and Torres Strait Islander Studies, including Aboriginal Press, Australian Aboriginal Studies Journal, research publications and newsletters; Australian Indigenous HealthInfoNet, including Australian Indigenous Health Bulletin and bibliography search; Closing the Gap Clearinghouse, including search of publications and general collection; Department of Families, Housing, Community Service and Indigenous Affairs (FaHCSIA), Indigenous families and children projects and programs, including footprints in time publications, Indigenous research and evaluations and families and children publications and articles; National Aborigines and Islanders Day Observance Committee, NAIDOC, including news and media releases; Department of Education, Employment and Workplace Relations, Parent and Community Engagement (PaCE) program, including all PaCE projects; Secretariat of National Aboriginal and Islander Child Care (SNAICC), including SNAICC clearinghouse and publications; The Lowitja Institute, including Lowitja Publishing Institute, CRCAH publishing and publications list; Multicultural Health Clearinghouse, Native American Health, including link to sites for Indian Health Service, National Institutes of Health Native American Health and National Library of Medicine American Indian Health; and First Nations Child and Family Caring Society of Canada database.

In most cases, we read titles of listed articles and abstracts were read if the titles appeared suitable. Where there was capacity for entering search terms, we specifically searched for articles relating to parenting.

Reference list searches

The reference lists of all included articles were searched for additional suitable articles. Using a snowball sampling strategy, we searched the references of any articles found to be eligible from the reference lists of the original articles, and so on, until the relevant references of all articles included in the review were screened for inclusion. Due to resource constraints, authors of potential articles or included articles were not contacted in an attempt to locate additional studies or data.

Article Selection

Title and abstract screening

Titles and abstracts from these searches were initially screened to determine if they were (1) studies or evaluations conducted in high-income countries with a history of colonization of, (2) programs or interventions for, and (3) Indigenous children and/or families. Wide variability exists with respect to determining whether any given individual is Indigenous, with strategies ranging from blood quantum to simple self-report. As such, we accepted all articles in which the participants were identified as Indigenous (in all forms contained in our search strategy) and met our other criteria.

Two raters were trained to 90% agreement by one of the authors (A.S.), and they then individually screened titles and abstracts. Articles with any degree of uncertainty were included in the next stage of screening.

Article screening

Full-text versions of articles passing the abstract screening stage, or where there was no abstract available, were obtained to determine if they were evaluations of programs for parents of Indigenous children. Author M.M. trained author B.D., and M.M. and B.D. took half of articles each and read them to determine suitability. Articles reporting the same program were reviewed by the same author. Papers and adherence to the inclusion/exclusion criteria were discussed throughout the process rather than using independent rating. Articles were read by both reviewers in order to be sure of suitability for inclusion. Author A.S. independently read the titles and abstracts of the articles that M.M. and B.D. excluded to confirm exclusion and reason for exclusion.

Articles were excluded if they were:

Studies of tools/measures—Articles reporting the development or testing of the psychometric properties of measures for use in programs or research with Indigenous people were removed for separate analysis to be reported elsewhere.

Solely drug trials—Articles reporting trials of drugs, vaccines, or supplements that included no other direct intervention with children and families. Programs combining, for example, supplements with education with families were acceptable.

Not family focused—Articles reporting programs for children only that did not involve the child’s parent/parents or other family members either as participant or as intervener (e.g., where a professional delivered the intervention directly to the child but a caregiver was not involved). Articles where it could not be determined if participant children and participant adults were members of the same family were also excluded.

Studies of non-Indigenous families—Articles reporting programs that did not involve any Indigenous people or where it could not be determined if any participants were Indigenous.

Not an evaluation of a program—This included articles such as ones describing programs or interventions, descriptive studies, prevalence of hearing impairment, assessment of reading skills, service audits, or review articles.

Article inclusion

Articles meeting the abstract and article screening criteria were assessed to determine that the intervention specifically targeted parents. Articles were eligible if the interventions they reported:

targeted parents as the recipients of interventions designed to assist Indigenous children aged up to 21 years,

were delivered directly to parents, and

included parents as the primary participants.

Exclusions counter to these criteria were:

interventions that targeted the child or person other than the parent,

interventions that attempted to reach the parent via the child, school, whole community, or other group, and

interventions in which the primary participant was the child, community, or other group and included a small secondary component for parents.

Article categorization

During the article selection process, we found that articles could be categorized into the following two overall domains: problems impacting child health outcomes and problems impacting child psychosocial functioning. For ease of reporting we have divided our scoping review into these two domains and only report on child psychosocial outcomes here.

Data Extraction

Author M.M. trained B.D. to extract data initially by reading articles and extracting data together, then by independently extracting data and comparing results. This process continued until the two reviewers had comparable results. As with article selection, the proceeding data extraction was a collaborative process, with discussion of articles and extracted data, rather than independent rating. Details of study design, population, intervention, comparison condition, and outcomes were extracted into an Excel spreadsheet specifically developed for this review. If there were queries regarding data to be extracted, such as uncertainty about program content or study design, these were resolved by discussion between M.M. and B.D.

The following information was extracted from articles, where available:

Study design, including whether randomized, use of comparison group, and when measures were taken;

Country, region, and cultural group;

Intervention group size, age, sex, marital status, education, and percentage of Indigenous participants if not all were Indigenous. Details were recorded for both parent and child participants;

Comparison group (if applicable) size, age, sex, marital status, education, and percentage of Indigenous participants if not all were Indigenous. Details were recorded for both parent and child participants;

Name and aim of program;

Target of the intervention;

Program mode, setting, content, delivery, and dose; and

Main findings, including significant and nonsignificant changes, descriptive findings, and satisfaction and acceptability ratings.

Data Analysis

After extraction, data were collated across studies to produce frequencies of study design, locations, population characteristics, intervention objectives, mode, setting, dose, and delivery methods. Intervention content was organized into themes and subthemes according to whom the content pertained (i.e. child, parent) and the topic area. Main findings were similarly analyzed according to themes. As the main objective of the scoping study was to map out rather than systematically review interventions, we did not undertake an assessment of the quality of the studies included in this review.

Results

Endnote was used to manage references, including its duplicate reference identification feature that allows users to visually check duplicate references before deletion. Database searches, references from consultation, gray literature, and hand searches yielded 64 studies (see Figure 1 for detail), 30 of which did not specifically target and deliver services directly to parents (see Table 1 List of Excluded Studies). There were 10 articles with abstracts that appeared relevant for which no full text could be located online. We e-mailed the authors and received responses from some, however, no full-text versions were obtained. These studies are also listed in Table 1. The remaining 34 articles were then categorized into those focusing on child psychosocial outcomes (n = 13 articles from 11 programs) and child health outcomes (n = 18 articles from 15 programs to be described in a companion article). Three additional articles from two programs were found to cover both types of outcome and will be discussed in both articles, yielding a final tally of 16 articles describing 13 programs relevant to child psychosocial functioning.

Figure 1.

Flow of articles through the scoping review.

Table 1.

Studies Excluded From Review Because They Did Not Target Parents or Because Full Text Could Not be Located.

Studies excluded because they did not target parents
Author/s	Year	Author/s	Year
Bruerd and Jones	1996	Macaulay et al.	1997
Bruerd, Kinney, and Bothwell	1989	Macaulay et al.	1998
Caballero et al.	2003	May and Hymbaugh	1989
Cunningham-Sabo et al.	2003	Mendenhall et al.	2010
Davis et al.	1999	Moncher and Schinke	1994
Davis et al.	2003	Moran	1999
Diken and Rutherford	2005	Paradis et al.	2005
Fejo and Rae	1995	Pierce-Bulger, and Nighswander	2001
Gittelsohn et al.	2003	Richardson	2005
Going et al.	2003	Richardson, Graf, Kleinschmit-Rembert, and Gordon	2006
Harrison, MacNab, Duffy, and Benton	2006	Richardson	2008
Himes et al.	2003	Rosecrans et al.	2008
Kegler and Malcoe	2004	Stacey	2004
Kegler, Malcoe, and Fedirko	2010	Steckler et al.	2003
Kim	2009	Stevens et al.	2003
Studies excluded because full text could not be located
Author/s	Year	Author/s	Year
Ishisaka	1975	Lamibe, Girardi, Romero, and Lena	2002
Ratnaike and Chinner	1994	Walker and Associates, Inc.	1978
Nansel	1998	Mayfield	1985
Tangentyere Council		King-Hooper, Schulz, and Watts	1996
Lambe	2005	Jackson	1986

There has been considerable debate as to whether scoping reviews should include findings from studies. Systematic review purists would contend (perhaps rightfully so) that any synthesis should include a meta-analysis (where possible) or a detailed narrative synthesis conducted where heterogeneity of population, intervention, design, measures and/or outcomes does not permit combining of studies. And yet, studies do report findings and their absence in a scoping review perhaps leave readers somewhat unsatisfied. We have chosen to follow a middle ground. We report whether studies found a significant (i.e., p < .05) difference among those who received a treatment but do not report on the type of statistics used, strength of findings (effect size), or any other specifics that would be more appropriate for a systematic review, nor do we make any statements that interpret, synthesize, count, or in any other way conclude that interventions included in this study are effective. We simply inform the reader so they can explore further if desired.

Given that the primary purpose of this scoping exercise was to determine the content, scope, and method of delivery of evaluated Indigenous parenting interventions, we focused our analysis primarily on program detail, rather than assessment of intervention effectiveness. Included are a brief overview of study design, population and program aim, and setting and mode. A detailed analysis of program delivery and content is provided, with a brief summary of the main findings of the studies. Study IDs are indicated in Tables 2 and 3.

Table 2.

Aims, Targets, Mode, Setting, Content, and Delivery of Interventions for Parents of Indigenous Children.

ID	Study	Problems addressed	Aim	Target of intervention	Model	Setting	Content	Delivery	Dose
The Shadow Project
1.	Boyd-Ball (2003)	Adolescent substance use	To prevent substance use	Family relationships, support, and understanding	Individual families	In-patient drug treatment facility	Identifying family and community supports, identifying barriers to abstinence	Discussion, plan, or strategy development, motivational interviewing, cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant, arranging family activity	Not indicated
BASIC Incredible Years Parenting Program
2.	Dionne, Davis, Sheeber and Madrigal (2009)	Hurtful parenting practices and insensitivity to children’s needs	To teach parenting skills in the context of traditional Native American cultural values and history	Parenting skills and knowledge	Individual families	Home	Parenting skills, child wellness, family strengths, family stressors, relationship-building play skills, noncorporal discipline approaches, differences between traditional Native American and European approaches to discipline, how to teach children to respect others by showing respect for the children	Discussion, motivational interviewing, watching video vignettes/examples, role-play, practice/rehearsal, cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant	Number sessions: mean = 8, range = 4–11 Duration of sessions: 1.5 hr Frequency of sessions: weekly
Filial Therapy Training Model
3.	Glover and Landreth (2008)	Disproportionate number of social and mental health problems in Native American population	To increase parents’ levels of acceptance of children, facilitate parents’ empathic responsiveness, reduce parental stress, enhance desirable play behaviors in children	Parent play skills	(1) Groups of parents (2) Individual parent–child dyads	(1) Not indicated (2) Not indicated	(1) How to play with children, how to create an accepting environment for children (2) Play skills	(1) Didactic teaching, modeling, role-play, discussion, provision of materials, performance feedback with the use of videotaping (2) Rehearsal, provision of materials	(1) Number of sessions: 10 Duration of session: 2 hr Frequency of sessions: weekly (2) Number of sessions: 10 Duration of sessions: 30 min Frequency of session: 10 weeks
Families and schools together
4.	Kratochwill, McDonald, Levin, Bear-Tibbetts and Demaray (2004)	High rates of school failure, negative academic and social behaviors in American Indian children	To increase academic competence among American Indian children and to reduce problem behaviors that have been found to be associated with school dropout	Family functioning— communication, identity, cohesion, and networks of support	(1) Groups of families	(1a) School	(1a) Phase 1—family and cultural identity and bond, understanding other family members feelings, play therapy, nonjudgmental child-initiated play, substance abuse	(1a) Phase 1—Cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant, drawing and other art, sharing experiences and feelings, role-play, peer support, discussion, didactic teaching, games, use of fun and laughter, lotteries and gifts with specific meaning for the family and program, didactic teaching, graduation and certificates	(1a) Number of sessions: 8 Duration of sessions: unclear, possibly 2.5 hr Frequency of sessions: weekly
					(1) Groups of families	(1a) School	(1b) Phase 2—as earlier	(1b) Phase 2—Summarizing program content	(1b) Number of sessions: 24 Duration of sessions: not indicated Frequency of sessions: monthly
					(2) Groups of children	(2) School	(2) Developmentally appropriate organized activities	(2) Didactic teaching, drawing and other art	(2) Number of sessions: 1 Duration of session: 1 hr
					(3) Group of parents	(3) School	(3) One-to-one adult time, parent self-help	(3) Sharing experiences and feelings, discussion	(3) Number of session: 1 Duration of session: 1 hr
Boomerangs Parenting Programs
5.	Lee, Griffiths, Glossop and Eapen (2010)	Significant problems impairing the development of secure mother–infant attachment	To teach parents attachment theory, to improve parents’ skills, to enhance parent sensitivity, to explore parents strengths, to build on parents strengths, and to reflect on trauma	Parents’ knowledge of attachment and child interactions and parents’ strengths	(1) Individual parent–child dyads	(1) Mental health service	(1) Play sessions	(1) Didactic teaching, performance feedback with the use of videotaping, purveyor asked questions	(1) Number of sessions: 2 Duration of sessions: not indicated Frequency of sessions: not indicated
5.	Lee, Griffiths, Glossop and Eapen (2010)				(2) Groups of parents	(2) Aboriginal Women’s Center and at a camp	(2) Brain development, attachment, constructive parent–child interaction	(2) Performance feedback with the use of videotaping, discussion	(2) Number of sessions: 20, including two camps Duration of sessions: camps = 3 days and 2 nights, Women’s center = not indicated Frequency of session: camps = 6 weeks apart, Women’s centre = not indicated
Family Group Decision Making
6.	Pennell and Burford (2000)	Family violence and child abuse and neglect	To prevent or reduce family violence	Family communication and support	Individual families	Not indicated	Information on reason for referral, information on topics such as addiction and impact of witnessing abuse on children, reducing family violence and maltreatment, promoting family well-being	Discussion, cultural activities, and/or materials either to promote cultural identity or to make the program culturally relevant, plan or strategy development, peer support, and active listening	Number of sessions: usually 1 Duration of session: usually 5.5 hr
Project Eagle
7.	Robbins, Tonemah and Robbins (2002)	Academic underachievement and adjustment problems in “gifted” American Indian adolescents	To offer gifted Native American children and parents a safe, culturally appropriate environment to express their feelings and thoughts	Expression of emotions	(1) Groups of parent–child dyads	(1) Not indicated	(1) How to share feelings, how to give and receive compliments, cultural identity, how to understand and express feelings, group and family bonding, cognitive processing, self-exploration, effective listening and expression, leadership, problem solving, cognitive processing, altruism, empathy, decision making, group cohesion, and conflict management	(1) Sharing experiences and feelings, cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant, games, active listening, purveyor asked questions, hearing family histories, gifts with specific meaning for the family and program	(1) Number of sessions: unclear, but possibly 4 Duration of sessions: range = 4–8 hr Frequency of sessions: not indicated, however total program duration is from autumn to spring
					(2) Individual parent–child dyads	(2) Not indicated	(2) Use of silence and listening, how it feels to not be heard, values of parents/child	(2) Sharing experiences and feelings, cultural activities, and/or materials either to promote cultural identity or to make the program culturally relevant	(2) Activities within the above-mentioned sessions
					(3) Groups of children	(3) Not indicated	(3) Children’s interests and problems	(3) Discussion	(3) Activities within the above mentioned sessions
					(4) Groups of parents	(4) Not indicated	(4) Concerns regarding child	(4) Discussion	(4) Activities within the above-mentioned sessions
Ngaripirliga’ajirri
8.	Robinson and Tyler (2006, 2008)	Serious social problems affecting young Tiwi people, their parents, and families	To address youth social problems, child behavioral concerns and encourage assertive nonaggressive parenting	Child social skills, family functioning, social relationships, and parenting management	(1) Groups of children	(1) For one of the communities, program was delivered in a school. Location not indicated for other communities	(1) Anger management, social skills training	(1) Play, drawing and other art, didactic teaching, prize for participation, praise, training, discussion, games, family relationships, stories, pictures and pictorial and visual clues, cultural activities, and/or materials either to promote cultural identity or to make the program culturally relevant	(1) Number of sessions: 8 Duration of sessions: 1 hr Frequency of sessions: weekly
					(2) Groups of parents	(2) As mentioned earlier	(2) Child behavior management (antecedents—consequences), positive parenting strategies to respond to difficulty in families, family functioning	(2) Plan or strategy development, discussion, drawing and other art, games, family relationships, stories, pictures and pictorial and visual clues, prize for participation	(2) Number of sessions: 8 Duration of sessions: 1 hr Frequency of sessions: weekly
					(3) Groups of parent–child dyads	(3) As mentioned earlier	(3) Management of emotions, recognition of antecedents and consequences of behavior, how to develop behavior management plans, exploration of current family issues	(3) Role-play, games, drawing and other art, active listening, dyadic teaching, modeling	(3) Number of sessions: 8 Duration of sessions: 40 minutes Frequency of sessions: weekly
Let’s Start
9.	Robinsonet al. (2009), Robinson, Tyler, Jones, Silburn, and Zubrick (2012)	Aboriginal disadvantage and the resulting higher rates of clinical, behavioral and emotional disorders and low performance on national literacy and numeracy tests	To reduce levels of problem behavior	Children’s social and emotional competencies, parental distress	(1) Group of parent–child dyads	(1) Darwin—family center, child care center Remote communities—school, preschool, women’s center, child care center	(1) Meditational strategies	(1) Discussion, cultural activities, and/or materials either to promote cultural identity or to make the program culturally relevant, play, drawing and other art, active listening, modeling, didactic teaching, family relationships	(1) Number of sessions: 10 Duration of sessions: 60–70 min Frequency of sessions: weekly
					(2) Group of parents	(2) As mentioned earlier	(2) Parenting, managing children’s behavior, patterns of relationship and roles within families, individual well-being, explore links between the child’s behavior and parenting, maintaining boundaries, parental expectations, dealing with conflict, cooperation with spouse, family of origin issues and how this relates to their own parenting style, development of behavioral strategies, triggers of problem behaviors, factors affecting parental well-being, parenting styles, children’s development	(2) Discussion, drawing and other art, pictures and pictorial and visual clues, plan or strategy development	(2) Number of sessions: 10 Duration of sessions: 50 min Frequency of sessions: weekly
					(3) Group of children (group runs concurrently with the group of parents above)	(3) As mentioned earlier	(3) Consequence-based learning, self-control, social skills, behavior management, managing emotions, managing excitement, playful cooperation, attunement to feelings, regulation of impulses, Stop-Do-Think model	(3) Play	(3) Number of sessions: 10 Duration of sessions: 50 min Frequency of sessions: weekly
Family Home Visiting Program (FHV)
10.	Sivak, Arney and Lewig (2008), Children, Youth and Women’s Health Service (2005)		To provide children with the best possible start in life and to assist families in providing the best support possible for their child	Parent–child attachment and needs of families, support for parents	Individual parent–child dyad	Home	Health checks, information on crying, safety, nutrition, dental health, immunization, infant cues, promote communication through books, setting limits, play and appropriate toys, toilet training, parental feelings about being a parent, difficulties in parent–child interaction parental mental health, contraception, parental physical health, smoking, alcohol and other drugs, community groups, family contacts, parenting support, support for grandmothers, decision-making and problem-solving skills, health and social supports in community	Didactic teaching, performance feedback with the use of videotaping, assistance with accessing services and support, provision of health checks and immunizations, goal setting, written material, discussion, praise, summarizing program content, modeling	Number of sessions: range = 1–34 Duration of sessions: unclear, possibly 1 hr Frequency of sessions: weekly for first 6 weeks, then fortnightly for next 6 months, then monthly up until child is 24 months
Program name not indicated
11.	Swanson and Henderson (1976)	Unequal educational effectiveness of schools in educating children from minority cultural backgrounds	To enable parents to influence children’s motivation toward reading by teaching them reinforcement principles and thus increase the child’s frequency of reading	Child’s interest in reading materials	(1) Groups of parents or individual parents	(1) Not indicated	(1) Social learning principles, use of verbal praise for attending behaviors, use of praise for child-initiated reading activity	(1) Modeling, role-play, written material	(1) Number of sessions: 5 Duration of sessions: not indicated Frequency of sessions: not indicated
11.	Swanson and Henderson (1976)			Child’s interest in reading materials	(2) Individual parent–child dyads	(2) Home	(2) As mentioned earlier	(2) Rehearsal	(2) Number of sessions: 3 Duration of sessions: 1 hr and 10 min Frequency of sessions: not indicated
Group Triple P for Indigenous Families
12.	Turner, Richards and Sanders (2007)	Poorer health and well-being of Indigenous children	To reduce child problem behaviors, reduce use of harsh and coercive parenting practices and to increase parental adjustment and reduce parental distress	Child management skills and knowledge	(1) Group of families	(1) Community health sites	(1) Child management strategies designed to help promote children’s competence and development (e.g., praise, engaging, incidental teaching) and manage (setting rules, clear instructions, consequences, and quiet-time), misplanned activities routine to enhance the generalization and maintenance of parenting skills, setting goals, planning for goals	(1) Modeling, practice/rehearsal, performance feedback without the use of videotaping, goal setting, discussion, cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant, plan or strategy development, graduation and certificates	(1) Number of sessions: 6 Duration of sessions: 1.5–2.5 hr Frequency of sessions: not indicated
12.	Turner, Richards and Sanders (2007)	Poorer health and well-being of Indigenous children		Child management skills and knowledge	(2) Individual parents	(2) Home	(2) Positive parenting strategies, refinement of parents’ ability to self-evaluate and solve future parenting issues independently	(2) Sharing experiences and feelings, practice/rehearsal	(2) Number of sessions: 2 Duration of sessions: 30–40 min Frequency of sessions: not indicated
Family Spirit
13.	Walkup et al. (2009)	Higher rates of environmental and behavioral risks for young American Indian mothers and offspring living on reservations	To provide young Native American mothers with culturally appropriate antenatal and postnatal home visits	Parenting knowledge and involvement with children	Individual parents	Home	Parenting information, family planning information, substance use prevention, problem solving, coping skills, infant care	Discussion, pictures and pictorial and visual clues	Number of sessions: median = 20 out of a possible 25 Duration: 1 hr Frequency: not indicated but program ran until 6 months post partum

Synthesis of Psychosocial Interventions Targeting Parents of Indigenous Children

Intervention details were synthesized and analyzed for themes. These generally fit within an ecological human developmental framework (Brofenbrenner, 1979), which was used to develop a graphic representation of the state of Indigenous psychosocial parenting program delivery as it has emerged from the reviewed evaluations (see Figure 2).

Figure 2.

Graphic representation of parenting programs for improving psychosocial outcomes in Indigenous children.

The figure depicts a summary of the aims, settings, modes, commonly used delivery methods, program content used in the reviewed programs, and domains of significant findings (underlined). These headings are listed across the bottom. Aims, mode, and delivery are ordered from the most to least frequently occurring, with n listed. Skills and knowledge imparted to families (content) appear on the right of the figure within the adaptation of Bronfenbrenner’s layered circles of ecological systems. The number of programs using content related to each system is indicated. Although this is not a systematic review and should not be used as an indication of effectiveness for any of the programs described here, systems where significant gains were found are underlined in order to provide readers with an indication of where hypothesized gains were found. These findings also appear in text in the next section but should be treated with great caution until validated by a more comprehensive systematic review.

Program aim

For nine of the 14 programs (Table 2), the overall purpose for implementing the interventions within these populations was to address the social, emotional, behavioral or mental health needs of children (2, 3, 4, 5, 7, 8, 9, 12, 13). Others focused on child education (4, 11), substance misuse (1, 2), peri- and postnatal outcomes (10, 13), and family violence (6).

Setting and mode

Programs (Table 2) were delivered to participants in home, school, and/or community settings. While the interventions were frequently multimodal (3, 4, 5, 7, 8, 9, 11, 12), the majority of programs were delivered to groups of parents (3, 4, 5, 7, 8, 9, 11).

Delivery methods

The predominant delivery technique (Table 2) was discussion (1, 2, 3, 4, 5, 6, 8, 9, 10, 12, 13) followed by the use of cultural activities and/or materials either to promote cultural identity or to make the program culturally relevant (1, 2, 4, 6, 7, 8, 9, 12). Examples of the Indigenous culture delivery include telling traditional stories, playing with culturally relevant toys, flag making, drumming, chanting, traditional dances, family meals with traditional foods, culturally meaningful images, traditional crafts, ceremonies such as naming, and the use of dream catchers and welcome home, medicine wheels, and talking feathers. Other examples include making teepees, putting yourself in someone else’s moccasins, and traditional singing/songs. Culturally meaningful delivery approaches bring the broader macrosystem into the intervention process.

Six of the programs employed modeling (3, 8, 9, 10, 11, 12) and didactic teaching (3, 4, 5, 8, 9, 10), while five used plan or strategy development (1, 6, 8, 9, 12) and role-play (2, 3, 4, 8, 11). Four programs used performance feedback either with (3, 5, 10) or without (13) the use of videotaping and four used active listening (6, 7, 8, 9). Three programs utilized pictures and pictorial and visual cues (8, 9, 13), sharing experiences and feelings (4, 7, 12), drawing and other art (4, 8, 9), practice/rehearsal (2, 11, 12), and games (4, 7, 8). Hearing family histories, culture, and family relationships was also used in three programs (7, 8, 9).

One article reported that one of their delivery techniques was to summarize program content after each session (4, 10). Other delivery techniques that were employed in only one or two studies (and do not appear in Figure 2) were praise (8, 10), lotteries and gifts with specific meaning for the family and program (4, 7), goal setting (10, 12), written material (10, 11), motivational interviewing (1, 2), peer support (4, 6), graduation and certificates (4, 12), having the person delivering the program ask participants questions to encourage input and learning (5, 7), play (8, 9), watching video vignettes/examples (2), prizes for participation (8), training (8), assistance with accessing services and supports, provision of health checks and immunizations (10), arranging family activities (1), provision of materials (3), and use of fun and laughter (4).

Program content (Table 2)

Within the overarching cultural macrosystem that underpinned much of the delivery of these programs, we found that all intervention content related to the child as the focal point, nested within more expansive layers, beginning with the parent and/or family microsystem, relationship mesosystem, and the community exsosystem.

Themes within these systems pertained to what was conveyed rather than who it was directed to. For example, content on child emotions came under the “child” theme, but it could have been directed to parent or child participants. Intervention content occasionally came under more than one theme, and themes were not discrete as content categorized under one theme may have been related to another (e.g., child behavior and child behavior management). Detail of specific intervention content within each of the themes follows, along with significant outcomes observed within the nested systems.

The child—the focal point of the intervention

Topics in the intervention relating to child content were in most cases delivered to parents, except in the programs that had specific child education components (4, 7, 8, 9). Within the theme of child content, the four subthemes were as follows: child development and learning, strategies for child self-improvement, child problems, and child health and safety.

Most of the content data came under child development and learning. Specific content covered under this theme included general child development (9), cognitive processing (7), brain development (5), developmentally appropriate activities (4, 10), communication and communicative cues (10), social learning principles (11), social skills (8, 9), play and toys (5, 10), attachment (5), and child’s values and child’s interests (7).

Content within the child self-improvement theme included sharing feelings, giving and receiving compliments, cultural identity (7); how to understand and express feelings (7, 9); leadership, self-exploration, effective listening and expression; problem solving, altruism, empathy, decision making and group cohesion (7); conflict management (7, 9); use of silence, how it feels to not be heard (7); anger management (8); antecedents and consequences of behaviour, managing emotions and impulses and behavior management (9).

The child problems theme included content about the underlying issue that needed to be addressed. The aim of providing this content was to help identify, clarify, or explain the nature of the concern in order to improve the situation for the child and parent. Content included barriers to substance abstinence (1), reason for child’s referral, addiction, impact of witnessing family abuse on children (6), crying (10), links between the child’s behavior and parenting and triggers of problem behaviors (9).

Not surprisingly, the theme with the least content was child health and safety as all but one article on child health outcomes were set aside for our companion review. Content on this topic included wellness (2), health checks, nutrition, dental health and immunization (10), and infant care (13).

Parent microsystem

Content related to parents and parenting was delivered to parents or families and was categorized into the following subthemes: strategies for parenting improvement, parent self-improvement, parent health, and well-being.

Most of the parent content related to strategies for parenting improvement. These focused largely on behavior management and strategies for improving parenting–child interactions and skills. The specific content covered included behavior management (8, 9); disciplining (2); developing behavior management plans (8) or behavioral strategies (9, 12); setting rules, giving clear instructions (12); consequences of behavior (9, 12), quiet-time (12); links between the child’s behavior and parenting (9); play skills/therapy (2, 3, 4, 5); sensitivity and responsiveness to child, allowing child to initiate interactions, encouraging child, following child’s lead, nonjudgmental child initiated play (4); constructive parent–child interaction (5); positive parenting strategies or parenting skills/information in general (2, 8, 9, 12, 13); use of praise (11, 12); engaging the child, incidental teaching, planned activities, routine to enhance the generalization and maintenance of parenting skills, goal setting (12); and promoting communication through books, setting limits, and toilet training (10).

Content that was also designed to assist with parenting but that was a bit broader was categorized into the parent self-improvement subtheme. These included the following content: self-help (4); cognitive processing, sharing feelings, giving and receiving compliments, cultural identity, how to understand and express feelings, self-exploration, effective listening and expression (7); problem solving (7, 13); altruism, empathy, decision making, conflict management, use of silence, how it feels to not be heard, parents’ values (7); parenting issues, parental expectations, dealing with conflict, cooperation with spouse, family of origin issues, and how this relates to parenting style, factors affecting parental well-being, understanding parenting styles (9); refinement of parents’ ability to self-evaluate and solve future parenting issues independently (12), parenting support (10), and coping skills (13).

There was also a subtheme on parent health and well-being, which included content on well-being in general (9); parental mental health (10); contraception and family planning (10, 13); smoking, alcohol, and other drugs; parental physical health; parental feelings about being a parent (10); addiction (6); and substance use (4, 13).

Family microsystem

There was less content that was specific to families as a whole, rather than just children or just parents. Subthemes related to family content were family problems, understanding the family, and strengths within the family.

The “family problems” theme drew together issues of concern or troubles in the family. Content on family problems included stressors (2), issues in family, family difficulties (8) and family violence (6). The theme “understanding the family” related to content on feelings of family members (4), family functioning (8), roles in families, and family of origin issues and how this relates to parenting style (9). Content on family strengths was also included in the program, such as family supports, bond and contacts (10), strengths (2), and well-being (6).

Relationship mesosystem

This system related to the interactions between members of the different systems, such as between parents and children, all family members, parents and other people, or children and other people. Much of the relationship content also fit into the child or parent themes and fell into two broad subthemes—parent–child interactions and general relationship builders. The authors of the review considered separating parental relationships from other types of relationships, but this seemed antithetical to both Bronfenbrenner’s intent and the emphasis, within many Indigenous cultures on relationships that extend far beyond parents.

Content in the first subtheme related directly to the nature of parent–child interactions and strategies for improving that relationship. This included play skills (to build relationships) (2), constructive parent–child interaction (5), nonjudgmental child initiated play (4), attachment (5), links between the child’s behavior and parenting (9) and difficulties in parent–child interaction (10).

The “general relationship builders” subtheme could also impact parent–child interactions as well as broader family relationships. This included mutual respect (4), impact of witnessing family abuse on children (6), sharing feelings, giving and receiving compliments, developing a family bond, how to understand and express feelings (9), and patterns of relationships in families (9).

Community exosystem

There was little community-related content in the programs reviewed here, only content related to supports in the community (1), community groups and use of health and social supports (10). The dearth of studies found with this focus is not surprising, given that community-level interventions for families were not specifically sought in this review. Future reviews that specifically target this system may find greater purchase in this area.

Study Details and Main Findings

Study design

The studies (Table 3) were predominantly controlled trials, with five non randomized controlled trials (1, 3, 6, 8, 11) and four randomized controlled trials (2, 4, 12, 13). There was no general trend for how groups were assigned in the nonrandomized controlled trials. Methods were based on referral or nonreferral to the program (6, 8), geographic location (3), parental involvement in a prior training program (11), and self-selection (1). The comparison conditions employed in the controlled trials varied, with treatment as usual (1, 4, 11) and waitlist (2, 3, 8, 12) used most frequently. Alternate treatment (13) and historical case files (6) were also used.

Table 3.

Study Design, Participant Details and Main Findings of Evaluations of Programs for Parents of Indigenous Children.

Study ID	Study & Cultural Group	Design	Participants		Main Findings
Study ID	Study & Cultural Group	Design	Intervention	Comparison	Main Findings
The Shadow Project
1.	Boyd-Ball (2003)United States Native American and AlaskanNatives from Western United States	Nonrandomized controlled trialTreatment as usualGroup allocation by self-selectionPre-post-follow-up measures	Family (n = 66, sample size of family members is not indicated)Demographics not indicatedChildren (n = 66)Demographics not indicated	Family (n = not indicated)Demographics not indicatedChildren (n = unclear, possibly 38)Sex—male = 54.7%Age—mean = 15.94 yearsEducation—high-school dropout = 28%, on target for graduation = 59%, referred for special education = 18.9%, mean highest grade completed = 9.68	Descriptive: abstinence from substance use increased for both intervention and control groups
BASIC Incredible Years Parenting Program
2.	Dionne et al. (2009) United States Native Americans in two southern California counties, Riverside and San Bernardino	Randomized controlled trial Wait list control Prepost measures Group allocation based on coin flip	Parents or relative guardians (n = 27) of Native American children Demographics of intervention sample not indicated Demographics of whole sample (including wait list group) Parents or guardians (n = 49) Type of parent/guardian—mothers = 85%, fathers = 2%, relative guardians = 14% Age—mean = 34 years, range = 19–93 years Employment—currently employed = 46% Marital status—currently married = 52%, ever married = 81% Ethnicity—Native American = 70%, Caucasian = 23%, Hispanic = 9%, African American = 5%, Asian = 2% Children (n = 49) Sex—male = 53% Age—mean = 6 years, range = 3–10 years	Parents or relative guardians (n = 22) of Native American children Demographics of waitlist sample not indicated Demographics of whole sample (including intervention group) Parents or guardians (n = 49) Type of parent/guardian—mothers = 85%, fathers = 2%, relative guardians = 14% Age—mean = 34 years, range = 19–93 years Employment—currently employed = 46% Marital status—currently married = 52%, ever married = 81% Ethnicity—Native American = 70%, Caucasian = 23%, Hispanic = 9%, African American = 5%, Asian = 2% Children (n = 49) Sex—male = 53% Age—mean = 6 years, range = 3–10 years	Significant: Significant group by time effect for child behavior. Significant pre to post improvements in parenting outcomes for intervention parents. Not significant: Nonsignificant improvements in parent–child relationship. Descriptive: 93% of the parents reported improvements in child behavior. 89% of the parents reported being more confidence in ability to discipline child and 93% of the parents reported acquiring new discipline techniques. 82% of the parents reported improvements in family difficulties not related to the child. Satisfaction: 93% of parents liked the program
Filial Therapy Training Model
3.	Glover and Landreth (2008) United States Native Americans from the Flathead Reservation in Montana	Nonrandomized controlled trial Wait list control Prepost measures Group allocation based on geographic location	Parents or primary caregivers (n = 11) Sex—female = 100% Age—mean = 37 years, range = 26–44 years Education—completed high school = 100%, completed some college = 7, bachelors degree = 3 Employment—employed = 73.7% Children (n = 11) Sex—male = 6, female = 5 Age—mean = 5.5 years, range = 3–10 years	Parents or primary caregivers (n = 10) Sex—female = 100% Age—mean = 32.7 years, range = 23–46 years Education—completed high school = 80%, completed some college = 7 Employment—employed = 60% Children (n = 10) Sex—male = 4, female = 6 Age—mean = 5.2 years, range = 3–9 years	Significant: Significant increases in desirable child play and child self-directedness post intervention. Significant increases in parental empathy during play session and in parent–child connectedness for intervention group but not control group. These increases were found in communicating acceptance, allowing the child self-direction and being involved with the children during play. Not significant: Nonsignificant increase in intervention children’s self-concept and self-esteem. Nonsignificant caregiver gains in their perceived acceptance of their children. Nonsignificant pre to post reduction in parental stress
Families and Schools Together
4.	Kratochwill et al. (2004) United States Three Native American Nations in Wisconsin	Randomized controlled trial Treatment as usual Pre-post-follow-up measures Control group matched on 5 variables (tribal heritage, school, grade level, gender and teacher ratings on the internalizing and externalizing scales of the child checklist)	Family (n = 50, sample size of family members not indicated) Parents (total number not indicated) Demographics not indicated Children (n = 50) Sex—female = 28, male = 22 Age—range = 4–9 years	Children (n = 50) Sex—female = 29, male = 21 Age—range = 4–9 years	Significant: significant posttest improvements in intervention children’s behavior but not in control children. Significant pre to post improvements in intervention children’s withdrawn status but not controls. Effects maintained at follow-up. Teacher ratings also found significant improvements for internalizing, anxious/depressed, attention problems and aggressive behaviors for intervention but not control children. Large effect sizes for the intervention but not controls were found for attention span problems, anxiety/depression, aggressive behavior, internalizing and academic performance
Boomerangs Parenting Program
5.	Lee et al. (2010) Australia Semi-rural or rural areas of the Sydney South West Area Health Service	Noncontrolled trial Prepost-follow-up measures	Parents (n = 3) Sex—female = 3 Age—26, 27, and 32 years Employment—part time = 1, not working = 2 Marital status—separated = 1, unclear = 2 Children (n = 3) Sex—male = 3 Age—2, 4, and 5 years	None	Descriptive: two of the three intervention parents increased the frequency of following their child’s lead and mutual gaze with the child, one parent increased the frequency of use of praise, and one parent increased the frequency of reading to their child, one child increased their frequency of requests for parents to read a book. Satisfaction: Parents gave mostly positive qualitative feedback about the program. Ratings of the impact the program had on the parents’ relationship with their children were 5, 9, and 10 of the 10
Family Group Decision Making
6.	Pennell and Burford (2000) Canada Three communities in Newfoundland and Labrador—Nain Inuit community on north coast Labrador, the Port au Port Peninsula settled by British, French and Micmac people, and St John with people with mainly Irish and British heritage	Nonrandomized controlled trial Historical comparison files—Child Protective Services Files of cases at the same historical time as those in the intervention. Comparison cases were divided into pre and post periods to indicate if they were before or after the median point of the intervention Prepost measures Participants were referred to the program by child welfare, parole, youth correction and probation authorities	Families (n = 32, total of 472 people) Included whomever the family identified as “family” such as extended family and friends 37 conferences were held with the 32 families. Number of conferences in each community (an indication of ethnicity of participants)—Nain = 14, Port au Port Peninsula = 11, St. John’s = 12 Demographics not indicated Children (n = 91 from the 32 families) Age—under 21 years = 100%	Families (n = 31) Ethnicity—Inuit = 10	Descriptive: reduction in the number of Child Protective Events for intervention group but increase for the control group. 66% of families reported being better off after completion of the program. Families ported increase family unity and safety, less child abuse and better care for children after completion of the program
Project Eagle
7.	Robbins et al. (2002) United States Native Americans from Arizona, Kansas, New Mexico, North and South Dakota, Oklahoma	Noncontrolled trial Postmeasure	Parents or other parental figure (n = 87) Sex—female = 61, male = 26 Children (n = 66) Sex—female = 39, male = 27 Age—range = 13–19 years, with most aged 15–17 years	None	Satisfaction: all seven satisfaction items were rated 4–5 of the 5. Qualitative feedback included “bonded me with my parent,” “improved my self-esteem,” “allowed me to share my feelings.” Areas for improvements included “would prefer a different location” and “there should be more sessions.”
Ngaripirliga’ajirri
8.	Robinson and Tyler (2006, 2008) Australia Three Tiwi communities—Nguiu on Bathurst Island and Milikapiti and Pirlingimpi on Melville Island	Nonrandomized controlled trial Wait list controls Prepost-follow-up measures Participating children were referred to the program by teachers and parents	Caregivers (n = 54) Type of caregiver—fathers = 6, step fathers = 1, mothers = 32, grandmothers = 7, step mothers = 5, aunts =3 Living arrangements for the 37 mothers/step mothers—lived with spouse = 18, lived without partner = 19 Children (n = 54) Age—range = 6–12 years	Children (n = 14) Education = grades 4–6 = 100%	Significant: significant declines in teacher ratings of intensity of child behavior and degree of problem with behavior causes. Improvements maintained across the duration of the program and at 6 month follow-up. Not significant: there was a nonsignificant pre to post decline in intervention parents’ reports of intensity and degree of problem of behavior. There were also nonsignificant improvements in reports of school attendance Descriptive: 80% of intervention children showed decreases in problem behavior at school and 50% of parents reported improvements in child behavior at home. Gains were maintained for 40% at 6 months. Qualitative reports from teachers and parents found parents of 60–80% of children reported improved communication with their child
Let’s Start
9.	Robinson et a l. (2009), Robinson et al. (2012)AustraliaAboriginals from three communities on Tiwi Island, two sites in Darwin, Palmerston and Jabiru. All cultural backgrounds in Darwin, as well as targeted Indigenous clusters	Noncontrolled trialPrepost-follow-up measures	Parent (total number not indicated)Demographics not indicatedChildren (n = 225)Sex—male = 69%Age—mean = 5 years, range = 4–6 yearsEthnicity—Indigenous = 131 (56%), non-Indigenous = 103 (44%)	None	Significant: significant pre to post reduction in intervention group’s problems behaviors and risk taking behaviors. These improvements maintained at follow-up. A significant pre to post improvement was also seen for parental distress.Satisfaction: very high levels of satisfaction with the program were reported
Family Home Visiting Program (FHV)
10.	Sivak et al. (2008), Children, Youth and Women’s Health Service, (2005)AustraliaAboriginals fromSouth Australia, Adelaide metro north, Adelaide metro south, Riverland, Port Augusta and Wyalla	Noncontrolled trial Mid- and post-measures	Family (n = 60) Type of family member—mostly mothers but some fathers and extended family members Age—mother = <20 years Children (n = not indicated) Demographics not indicated	None	Descriptive: program benefits noted by participants included practical assistance, information and referrals, feeling more supportive in parents in decisions. Service referrals, health checks, and talking to staff were beneficial. Satisfaction: positive feedback was reported by most intervention families. The program was seen as convenient, responsive, and positive, delivered in an empowering and respectful way
Program name not indicated
11.	Swanson and Henderson (1976) United States Papago Native Americans on the Papago Indian reservation, Arizona	Nonrandomized controlled trial Treatment as usual Prepost measures Controls were randomly selected from a group of nonintervention children and were used for the classroom generalization task only	Parents (n = 20) Sex—female = 100% Children (n = 20) Education—second grade	Children (n = 20) Education—second grade	Significant: significant increase in intervention children’s preferences for reading materials during free choice and classroom situations was found post intervention. Descriptive: in parent observations child play sessions, 78% of the children read for 30 minutes or more, 71% engaged in self-initiated activity for 45 min or more and 21% engaged in 60 min of self-initiated reading
Group Triple P for Indigenous Families
12.	Turner et al. (2007) Australia Aboriginals in Brisbane	Randomized controlled trial Waitlist controls Prepost-follow-up measures Parents or carers presenting to a community health site with concerns about children’s behavior or parenting skills were referred to program	Families (n = 26, total of 52 people) Parent (n = 26) Sex—female = 88% Age—mean = 34.52 years Education—less than senior = 79.2%, senior = 4.2%, college/tertiary = 16.7% Employment—full-time = 24%, part-time = 16%, not employed= 60% Marital Status—two parent family = 64% Children (n = 26) Sex—male = 65.4% Age – mean = 6.17 years	Families (n = 25, total of 50 people) Parent (n = 25) Sex—female = 92% Age—mean = 30.87 years Education—less than senior = 52%, senior = 20%, college/tertiary = 28% Employment—full-time = 20%, part-time = 12%, not employed = 68% Marital Status—two parent family = 76% Children (n = 25) Sex—male = 64% Age—mean = 5.52 years	Significant: significant condition by time effect for behavior intensity and degree of problem associated with behavior. A large effect size on intensity was observed for the intervention group but no effect for the control group. There was a moderate effect on how much of a perceived problem the child behavior causes for the intervention group and a small effect for the control group. Parent ratings of child behavior showed a significant improvement in ratings of child pro-social and difficult behaviors for the intervention group only. Improvements were maintained at follow-up. Significant pre to post decrease in intervention but not control groups’ use of dysfunctional parenting strategies. Not significant: nonsignificant between group differences were found for parental adjustment. Satisfaction: high satisfaction ratings were reported for the group program and qualitative data collected regarding the cultural acceptability of the program were positive
Family Spirit
13.	Walkup et al. (2009) United States Navajo and White Mountain Apache reservations in New Mexico and Arizona	Randomized controlled trial Alternate treatment—Home visiting program involving breast feeding and nutrition education. Dose − 23 × 1 hr visits Prepost-follow-up measures	Parents (n = 116) Sex—female = 81 (pregnant at program commencement), male partners enrolled in the program= 35 Demographics for female participants only Age—14–17 years = 44%, 18+ years = 56% Education—high school/general equivalency diploma/some college =38% Employment—employed = 11% Marital status—married = 11% Children (n = 81) Demographics not indicated but program ceased at 6 months postpartum and final measure was taken at 12 months postpartum	Parents (n = 131) Sex—female = 86 (pregnant at the time of program commencement), male partners enrolled in the program = 45 Demographics for female participants only Age—14–17 years = 44%, 18+ years = 56% Education—high school/general equivalency diploma/some college =41% Employment—employed = 13% Marital status—married = 6% Children (n = 86) Demographics not indicated but program ceased at 6 months postpartum and final measure was taken at 12 months postpartum	Significant: significant pre to post improvement in intervention children’s but not controls peer activity and impulsivity, peer aggression, overexternalizing behaviors and separation distress. Significant increase in intervention but not control group parenting knowledge at 6 and 12 months. Not significant: nonsignificant intervention group improvements were found for maternal involvement in infant care and stimulation of the child in the home. Nonsignificant between group differences were also found for maternal social support, parent depressive symptoms, substance abuse, parenting stress and parent support

The remaining studies were noncontrolled (5, 7, 9, 10) and consisted of single-group pre-post designs (5, 9), mid-intervention and post measures (10), and posttest-only measures (7).

Location and population

The majority of studies (Table 3) were conducted in the United States (1, 2, 3, 4, 7, 11, 13) and in Australia (5, 8, 9, 10, 12). Only one Canadian program (6) was found that matched the inclusion criteria. The participants were identified as Native American (1, 2, 3, 4, 7, 11, 13), Alaskan Natives (1), Aboriginal Australians (8, 9), and Inuits (6). Three studies (2, 6, 9) were conducted with a proportion of non-Indigenous participants in addition to the Indigenous sample, however, the Indigenous families were the foci of the interventions. Details of the population and location can be found in Table 2.

Where indicated, caregivers were predominantly female and typically they were mothers (2, 3, 5, 7, 8, 10, 11, 12, 13). Males made up the greater proportion of child participants in more studies (2, 3, 5, 9, 12) than females (4, 7), possibly due to the greater prevalence of behavior problems among boys (Moffitt, Caspi, Rutter, & Silva, 2001). Sample sizes varied greatly, from 3 parents (5) to 472 individuals from 32 families (6). Target children were aged from birth to adulthood, with the majority of programs aiming at younger children (2, 3, 4, 5, 8, 9, 11, 12, 13).

Significant findings within each system

Several studies found significant gains for children (see Figure 2 for underlined systems with significant gains; Table 3 under main findings). The specific outcomes for which significant effects were observed were behavior (2, 4, 8, 9, 12, 13), academics (4, 5), and play (3). In the parent microsystem, significant improvements were found for parenting style and knowledge (2, 12, 14) and parent stress (9). Within the relationship mesosystem, one study (3) found significant improvements in aspects of parent–child interaction. There were no significant family microsystem or community exosystem gains found in this review.

Discussion and Application to Social Work

This work represents the first known review of programs for parents of Indigenous children. Although there have been several reviews, systematic and otherwise, on parenting in the general population, little is known about the many programs implemented specifically targeting Indigenous parents throughout the colonized world. By first conducting a scoping rather than a systematic review on this new area of inquiry, we aimed to gather all relevant program evaluations and provide a detailed map of program delivery, content, study design, and findings. A systematic review with a greater focus on effectiveness has been registered with the Cochrane Collaboration. Nonetheless, this scoping review provides consumers, developers, and researchers with a topographical map, as it were, of the range of parenting programs in this area and places them within an ecological framework

An extensive search of the published and unpublished literature yielded 2,418 articles, 16 of which met our eligibility criteria representing 13 distinct programs. Four of the studies were randomized controlled trials, with a mixture of usual care, waitlist controls, and alternate treatment conditions employed for the comparison samples. Studies were predominantly conducted in the United States and Australia, and all programs, to some extent, involved children in addition to parents. Child social, emotional, behavioral or mental health needs were targeted in nine of the 16 articles, and programs were most frequently delivered to groups of parents in the form of discussion, modeling, didactic teaching, and plan development. Several programs also utilized cultural activities or materials in their delivery methods, and the integration of such activities is what sets these programs apart from more mainstream parenting programs. Program content was most frequently in the areas of children development, learning and skills and strategies for parenting improvement, particularly with managing child behavior and improving parent–child interactions. Great caution is required when appraising, synthesizing, and interpreting results of effectiveness, and this scoping review is not intended to provide answers. As such, we can only say that the findings of some of these evaluations reported significant and sometimes substantial improvements in several areas including child behavior, academic performance, play, parenting skills, parent–child interactions, and parent distress. These results will be further explored, appraised, synthesized, and, to the extent possible, validated in an upcoming systematic review.

Few evaluations were found for programs designed to address child substance misuse, domestic or family violence, child maltreatment or child education, although the secondary or long-term aims of some of the interventions may have been to affect these outcomes. Most of the eligible studies were conducted in the United States or Australia, so little is known about similar programs that have not been evaluated in other countries with Indigenous, postcolonized populations such as Canada and New Zealand.

Additional gaps in knowledge also exist because of a lack of clarity of reporting or a general lack of reporting of program details. For several of the reviewed studies, we found that it was difficult to determine what was undertaken in the program (mode, setting, dose, delivery methods, content) as information was sparse, not described, and therefore open to interpretation, and authors often assigned terminology inconsistently across studies to describe the same concept. For example, one article referred to the use of training as a delivery method, but there was no clear indication of what this constituted. In order to determine the effectiveness of an intervention, suitability of a program for implementation, and to implement a program as intended, there need to be minimum standards of reporting of intervention evaluations (e.g., following Consolidated Standards of Reporting Trials [CONSORT] guidelines for the reporting of clinical trials).

Our search of academic databases, gray literature sources and Indigenous organization websites was extensive and therefore may have reduced systematic and publication bias. It was also structured similarly to searches conducted in well-executed systematic reviews. Nonetheless, some eligible articles may have been missed. The inclusion of other databases, such as Embase, or the inclusion of further Indigenous organization websites may have produced additional published or unpublished literature. Furthermore, authors of included articles were not contacted to seek additional articles or data and 10 articles could not be obtained despite attempts to contact authors.

Another aspect of program design that was not considered in this scoping exercise involved a detailed reporting of the theoretical approaches underlying the development of the interventions. In particular, Aboriginal theories, especially as they relate to children, families, and communities, might better inform the analysis of these parenting programs. Future reviews may consider incorporating a study of theoretical approaches into their analyses.

This scoping review provides some information about the types of programs conducted around the high-income world with parents of Indigenous children. Programs were found to be acceptable to the participants and some benefits were observed. While an analysis of effectiveness was beyond the scope of this review, this study provides program purveyors with some useful information about the state of interventions for this population. For example, the graphic depiction of interventions targeting Indigenous parents shows that programs were more often directed at groups of parents, employed discussion and cultural activities and materials as teaching tools, and used content pertaining to the child and at the parent microsystem level. Significant gains were mostly observed at the child level and within the parent microsystem and the relationship mesosystem.

The delivery and content of the parenting programs for Indigenous families is similar to that found in more typical parenting programs targeting the general population. Both Indigenous and general parenting programs often involve delivery in the home, both are typically no more than 30 sessions in duration and delivery is often in group format. Content in both Indigenous and parenting programs for the general population often involves parenting skills training and information about child development. The notable difference between programs for Indigenous parents and general parenting programs lies in the inclusion of cultural content. The inclusion of cultural content extended beyond translation, interpretation, or adaptation and can better be described as the infusion of cultural content with core parenting content that is, perhaps, thought to transcend culture. For many of the programs, Indigenous culture was at the heart of the development of the program and was imbedded in all aspects of content and delivery. Although the comparative effectiveness of these Indigenous parenting programs versus general parenting programs is unknown, as is the effectiveness of Indigenous parenting programs with more compared to less culturally meaningful elements, the infusion of culturally derived content may serve to better engage parents in programs. If true, overall child outcomes may be improved using such approaches.

A systematic review and, where appropriate, meta-analysis, is needed to determine the degree of effectiveness of these programs. To be better placed to conduct a systematic review, future programs for Indigenous parents and children need to be evaluated using rigorous designs, such as randomized controlled trials with contemporaneous controls that include pre, post, and maintenance measures. Although study quality or program effectiveness was not assessed here, the lack of rigorous research designs, measurement of outcomes, and reporting of findings was evident.

This scoping review has mapped out the details of programs conducted internationally for parents of Indigenous children in high-income countries with a history of colonization and has provided key information about their evaluations. In addition to tabulating and providing textual descriptions of the work, a graphic representation of the synthesis as it relates to Bronfenbrenner’s ecological theory can be used by developers, clinicians, and researchers to guide the content and delivery of future programs as well as the adaptation of existing programs.

There have been limited rigorous evaluations of programs geared toward working with this population. Programs appear to be acceptable and culturally appropriate according to participants, however, further research is needed in order to determine whether these culturally infused interventions lead to better outcomes for children and families.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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