Ward et al. BMC Public Health 2011, 11:431 http://www.biomedcentral.com/1471-2458/11/431 Page 5 of 9 Parent Program The parent meetings are facilitated discussions about select parenting skills, and initial sessions address general parent- ing topics including: parenting style, child behavior manage- ment, stress management, coparenting relationships, and family routines. Later sessions show parents how to apply these skills to promote healthy nutrition and physical activ- ity behaviors in their children. Table 2 summarizes the key parenting and health messages in each of the sessions. Par- ents receive personal counseling calls from the intervention- ist between each of the sessions. This call is used to discuss successes and challenges encountered as the parent tries to implement the new skills from the previous session. Moti- vational interviewing informed techniques are used by the facilitator during these calls, working to encourage partici- pants to identify their own challenges and options for over- coming those obstacles. Child Program The child program grew out of our pilot work where parents indicated that a program beneficial to their child, rather than just offering child care, would pro- vide additional motivation for their own attendance. The child program is designed to reinforce the parent program and prepare children for changes they would be seeing at home related to new parenting practices and the encouragement to eat healthy and be active. Each session follows a set routine that incorporates active play time, a family-style meal, a music and movement game, an enrichment activity, a new food taste testing, and story time. Specific games, activities, and books are selected to reinforce that week’s key les- son. Lesson topics include: rules and limits, emotions, working as a family and family routines, and healthy lifestyles. Table 2 Intervention overview Introduction to creating routines that can improve efficiency and predictability at home Planning time for healthy meals should be part of morning and evening routines Sessions Stress management Parenting style Emotion regulation Coparenting Family routines Physical activity and activity practices (2 sessions) Sleep habits Child management (2 sessions) Strategies for managing child behavior (attending, reinforcement and rewarding, effortful ignoring, setting clear rules and limits, choices, consequences, time out) Key parenting messages Identification of common parenting stressors Effect of stress on parenting Strategies for managing stress Introduction of 4 major parenting styles (authoritarian, authoritative, indulgent, uninvolved) Importance of balancing warmth and support with discipline Improve understanding of how parents contribute to their child’s emotional development through role modeling, their own response to their emotions, and their parenting behaviors Strategies for strengthening the communication between coparents so that they can present a united front Nutrition and Routines can help parents find the time to plan, prepare, and eat feeding practices meals as a family (2 sessions) Use of the authoritative parenting style and choices can help parents encourage healthy eating Attending and verbal praise is a way to reinforce children’s healthy choices Planning ahead can help parents make the time for family activity Rethinking house rules to accommodate active play Using rules and limits to manage time children spend in sedentary activities Creating bedtime routines can help parents get children to bed with fewer battles Incorporating quality time between parent and child as part of the bedtime routine Using child management skills to help limit/discourage the child from repeatedly getting up during the night Nutrition/PA messages/activities Examples of ineffective coping strategy = using food/ alcohol as source of comfort Examples of effective coping strategies = taking care of yourself - eating a healthy diet and getting regular exercise Discuss strategies that parents with different styles might use to get their child to eat fruits and vegetables, and the pros and cons of each Use of attending and verbal reward to encourage intake of healthy foods Alternatives to using food as a reward or bribe to control child’s behavior Re-emphasize examples of ineffective and effective coping strategies and that children will learn these from their parents’ example Food should not be a substitute for love and affection Encouraging parents to present a united front when it comes to healthy habits Introduction to the food guide pyramid Identification of go, slow, and whoa foods Appropriate portion sizes Family meals Overcoming picky eating behaviors Introduction to physical activity guidelines for adults and children Examples of different levels of activity Age-appropriate physical activities Being active as a family Managing media time Sleep recommendations for children and adults Adverse health outcomes associated with insufficient sleep