Parents as Coaches (PAC)
’ behaviors
PAC focuses on parent skills training to support adolescents’ weight management. It includes combined nutrition education sessions with adolescents, as well as independent parent skills training group sessions, delivered while adolescents attend their own BWL groups. The TEENS+ coach is a co-facilitator of the parent sessions, to facilitate integration of content between the adolescent and parent treatments. Parents are taught authoritative parenting skills (providing structure with warmth), and strategies for applying this approach to weight management (e.g., setting limits around food kept in the house). PAC teaches positive reinforcement principles to promote behavior change, the importance of role modeling, and communication about eating and weight. Throughout, developmentally appropriate strategies to promote adolescent behavior change are emphasized. For example, parents are taught strategies for assisting their child (as needed) with logging caloric intake, highlighting the consistency of this behavior with the adolescent’s goals. This approach reduces adolescent resistance and increases autonomy, while enhancing skill development. As skills are demonstrated, parents provide positive reinforcement, and re-negotiate the level of assistance needed. In PAC, parents’ own weight management is not specifically addressed, and parent weight is not monitored. However, PAC emphasizes the importance of parents’ modeling of healthy behaviors, the value of healthy eating and exercise for the entire family (regardless of weight), and the importance of setting up the home environment to facilitate their adolescents’ successful goal attainment. PAC also emphasizes the critical need for all caregivers to use consistent feeding strategies and teaches parents strategies for communicating these concerns assertively.Parents set specific goals each week, related to PAC treatment targets, which focus efforts on areas within their control that impact adolescent weight management behavior. Specifically, parents maintain a log to self-monitor: the number of meals planned and prepared at home for their adolescent; whether they reviewed their adolescents’ logs; responsibility for adolescent logging (parent/child/combined); and provision of Go Food and PA opportunities for their adolescent. Progress on goals is reviewed weekly, facilitating group brainstorming of strategies to overcome barriers and positively reinforce successes. Behavior coaches also deliver personalized coaching in brief individual check-ins before group, and examine the relation between parental behaviors and adolescents’ behaviors and weight change, guiding adjustments as needed to assist in goal attainment. In these ways, coaches guide parents to focus on empirically-supported strategies within their control to foster healthy adolescent behavior changes.