Innovative interventions accessible to at-risk populations to prevent the intergenerational cycle of toxic stress are needed. This paper describes the iterative development of a community-based intervention, 2Gen Thrive, which was designed to prevent toxic stress and promote resilience by improving caregiver capacity to respond to children’s emotional, behavioral, and developmental needs. 2Gen Thrive leverages the collaboration between a Children’s Hospital and an Early Head Start/Head Start education center to help low-income, minority families thrive in the context of risk factors for toxic stress. In this paper, we focus on the process of developing, piloting, and refining our 2Gen Thrive preventive intervention research program, which has been developed following a community-based participatory research (CBPR) approach. The primary objective was to pilot test two prevention interventions we adapted for use in this target population: Classroom Theraplay, a classroom-wide intervention designed to prevent toxic stress among children exposed to adversity by fostering nurturing relationships with their teachers; and Dialectical Behavior Therapy Skills Training for Parents (DBT4P), a group intervention developed to bolster parental responsiveness by teaching Dialectical Behavioral Therapy (DBT) mindfulness and emotion regulation skills. We evaluated qualitative and process data as well as quantitative data from standardized instruments, including The Classroom Assessment Scoring System (CLASS), Patient Health Questionnaire (PHQ-9), Difficulties in Emotion Regulation Scale (DERS), and Parenting Stress Index (PSI/SF). Results demonstrate the feasibility, acceptability, and appropriateness of these preventive interventions delivered in the early education setting, and of conducting intervention research using a CBPR approach.
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B.W.J.: designed and executed the study, assisted with data analyses, and wrote the paper. C.C.S.: collaborated with the design and execution of the study, data analyses and writing of the paper. B.G.: collaborated with the design of the study and wrote part of the method. E.S.: analyzed the data and wrote part of the results. L.S. and V.T. assisted with writing of the results and editing the final manuscript. D.O.: collaborated in the editing of the final manuscript.
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in this study were in accordance with the ethical standards of the Children’s Mercy Hospital Institutional Review Board and with the 1964 Helsinki declarations and its later amendments or comparable ethical standards
Informed consent was obtained from all individual participants included in the study.
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Woods-Jaeger, B.A., Sexton, C.C., Gardner, B. et al. Development, Feasibility, and Refinement of a Toxic Stress Prevention Research Program. J Child Fam Stud 27, 3531–3543 (2018). https://doi.org/10.1007/s10826-018-1178-1
- Adverse childhood experiences
- Toxic stress
- Caregiver capacity