Stepping Stones Triple P seminars for parents of a child with a disability: a randomized controlled trial

Parents of children with a developmental disability require tailored parenting support, as their families have special needs and are at risk of increased burden. The aim of this study was to evaluate the efficacy of the Stepping Stones Triple P seminars, a brief group intervention for parents of a child with a disability. There were two seminars that presented parenting strategies to improve both child behavior and parenting variables implicated in the development and maintenance of child problem behavior. Fifty-three parents participated in this randomized controlled trial. Each had a child, aged two to ten, with a disability. The results indicated significant reductions in child behavior problems, the use of dysfunctional parenting styles, and parental conflict reported by parents in the intervention group compared to a waitlist group. The results were maintained at 3-month follow-up and there was evidence of a sleeper effect for parenting confidence. This study demonstrated that the seminars provide a promising intervention for parents of children with a disability. Limitations and implications for future research are also discussed.     

Modifying the ‘Positive Parenting Program’ for parents with intellectual disabilities

Background Many parents with intellectual disabilities (ID) want and/or need professional guidance and support to learn skills and strategies to prevent and manage child behaviour problems. However, the available support is rarely suitable, and suitable support is rarely available. The aim of this study was to determine whether a popular mainstream parenting training programme, known as ‘Group Triple P’ (Positive Parenting Program), could be successfully modified for this parent group. Method A pilot study was undertaken to determine whether a modified version of Group Triple P would engage and retain parents with ID. A non‐experimental, pre‐test post‐test study, involving a total of 30 parents with ID, was then undertaken to obtain preliminary efficacy data. Results Parent engagement and participation levels were high. No parent ‘dropped out’ of the programme. After completing the modified Group Triple P programme, parents reported a decrease in psychological distress, maladaptive parenting and child conduct problems. Parents reported high levels of satisfaction with the information and support they received. Conclusion Research‐informed adaptation of mainstream behavioural family interventions, such as Group Triple P, could make ‘suitable support’ more readily available, and more engaging for parents with ID.     

17 tips on parenting--which strategies do parents apply?

The necessity to make available education support to parents is undisputed because of the epidemiology of child behavior problems. Parent trainings are a method to increase parenting competence. Triple P as a successful example of a parenting and family support program is introduced briefly with his theoretical bases, intervention levels, basic principles and education strategies. In addition, findings are reported to the effectiveness and consumer satisfaction. The present work examines which Triple P-strategies use parents after the training in the everyday life. The data come from the project "Zukunft Familie" in which the long-term effectiveness of the Triple P-training was examined in a controlled study in 280 families. 144 parents took part in the Triple P-group training and filled before, directly after the intervention and with 1-year-follow up questionnaires to the education strategies. The results show that the positive education strategies were used for promotiong child development already before the training more often as the ideas to managing misbehavior. More than 90% of the parents, above all, the positive education strategies also practised with the 1-year follow-up. In addition, there was a significant decrease by the use of the "time out"-strategy.     

Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities

This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities. Families were randomly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills (SSTP-E), standard parent training intervention alone (SSTP-S) or waitlist control (WL) condition. At post-intervention, both programs were associated with lower levels of observed negative child behavior, reductions in the number of care-giving settings where children displayed problem behavior, and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. Gains attained at post-intervention were maintained at 1-year follow-up. Both interventions produced significant reductions in child problem behavior, with 67% of children in the SSTP-E and 77% of children in the SSTP-S showing clinically reliable change from pre-intervention to follow-up. Parents reported a high level of satisfaction with both interventions.     

Reducing Work and Family Conflict in Teachers: A Randomised Controlled Trial of Workplace Triple P

The purpose of this study was to evaluate the efficacy of a workplace parenting intervention aimed at reducing work–family conflict and improving work and family functioning in teachers. One hundred and seven teachers (who were also parents) were randomly allocated to either a Workplace Triple P intervention condition or a waitlist control condition. Analyses indicated the intervention had a positive effect on a range of occupational variables including work-to-family conflict, family-to-work conflict, occupational stress and teaching efficacy. Intervention effects were also found for family- and personal adjustment-related variables including dysfunctional parenting styles, child behaviour, parenting efficacy, and depression and anxiety. Small to large effect sizes were obtained (Cohen’s d = .34–.85), and all intervention effects were maintained at 4-month follow-up. The results indicate that a parenting intervention can reduce work–family conflict and occupational stress and improve family functioning in teachers balancing work and family. The implications for supporting teachers with family interventions delivered in the workplace are discussed.     

Balancing Work and Family: A Controlled Evaluation of the Triple P- Positive Parenting Program as a Work-Site Intervention

Background: Despite a wealth of evidence showing that behavioural family intervention is an effective intervention for parents of children with behavioural and emotional problems, little attention has been given to the relationship between parents functioning at work and their capacity to manage parenting and other home responsibilities. This study evaluated the effects of a group version of the Triple-P Positive Parenting Program (WPTP) designed specifically for delivery in the workplace.
Method: Participants were 42 general and academic staff from a major metropolitan university who were reporting difficulties managing home and work responsibilities and behavioural difficulties with their children. Participants were randomly assigned to WPTP, or to a waitlist control (WL) condition.
Results: Following intervention, parents in WPTP reported significantly lower levels of disruptive child behaviour, dysfunctional parenting practices, and higher levels of parental self-efficacy in managing both home and work responsibilities, than parents in the WL condition. These short-term improvements were maintained at 4-months follow-up. There were also additional improvements in reported levels of work stress and parental distress at follow-up in the WPTP group compared to post-intervention.
Conclusions: Implications for the development of 'family-friendly' work environments and the prevention of child behaviour problems are discussed.     

Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: a randomized controlled trial

Externalizing problem behaviour is one of the most common childhood disorders. Parent training is an effective treatment for these children and there is growing interest in the effects of parent-administered interventions with minimal therapist contact. This randomized controlled study examined the efficacy of a telephone-assisted parent-administered behavioural intervention (bibliotherapy) in families with preschool children with externalizing problem behaviour. Families were randomly assigned to a treatment group (n = 26) and an untreated waitlist control group (n = 22). The intervention comprised the reading of an 11 chapter self-help book and 11 weekly telephone consultations. Compared to the control group, the treatment group demonstrated significant decreases in parent-reported externalizing and internalizing child problem behaviour and dysfunctional parenting practices. Moreover, treated parents reported less parenting-related strains and decreases in parental depression, anxiety, and stress. The results suggest that telephone-assisted self-administered parent training is an effective alternative to more intensive forms of behavioural family intervention for preschool children with externalizing problem behaviour.     

The effectiveness of a Group Triple P with Chinese parents who have a child with developmental disabilities: A randomized controlled trial

The study examined the effectiveness of Group Triple P, a Level 4 variant of the Triple P multilevel system of parenting support, with Chinese parents who had a preschool aged child with a developmental disability, using randomized controlled trial design. Participants (Intervention group: 42; Waitlist Control group: 39) completed measures on child behaviour, parental stress, dysfunctional discipline styles and parental conflict before and after program completion by the Intervention group. Intervention group participants also completed these same measures six months after program completion. Compared to the Waitlist Control group, parents receiving Group Triple P reported significantly lower levels of child behaviour problems, parental stress, dysfunctional discipline style and parental conflict scores. The Intervention group participants maintained their gains six months after program completion. The results provided promising evidence for the Level 4 Group Triple P as an effective intervention program for Chinese parents who have preschool aged children with developmental disabilities.     

The relation between parenting stress and adolescents' somatisation trajectories: A growth mixture analysis

ObjectiveThe impact of somatisation in adolescence is substantial. Knowledge on (predictors of) individual-level development of somatisation is necessary to develop tailored treatment. The current study assessed individual-level development of somatisation by means of latent mixed modelling. Parenting stress was included as a predictor of somatisation trajectory membership and within-trajectory variation.MethodsA total of 1499 adolescents and one of their parents (mostly the mother) agreed to participate. Questionnaires were administered when the adolescents were respectively 12–13 (T1), 13–14 (T2), and 14–15 (T3) years old. Adolescents reported on their somatisation, parents on their parenting stress.ResultsFour individual somatisation trajectories were found: increased, long-term low, long-term high, and decreased. Higher early parenting stress (T1) significantly predicted less favourable trajectory membership (increased and long-term high). The relation between later parenting stress (T2 and T3) and somatisation depended on trajectory membership. For adolescents in the long-term high and decreased somatisation trajectories, lower T2 and T3 parenting stress was related to higher somatisation, while for adolescents in the long-term low and increased trajectories, higher T2 and T3 parenting stress was related to higher somatisation.ConclusionsThe results support a general recommendation to prevent the onset of high levels of parenting stress. In addition, for families in which high levels of parenting stress already exist, clinicians should be aware of natural fluctuations in parenting stress, its associated features (e.g., aspects of overall care, like looking for professional help) and of the consequences this might have for the adolescent.     

Effectiveness of the Triple P Positive Parenting Program on behavioral problems in children: a meta-analysis

The Triple P Positive Parenting Program is a multilevel parenting program to prevent and offer treatment for severe behavioral, emotional, and developmental problems in children. The aim of this meta-analysis is to assess the effectiveness of Triple P Level 4 interventions in the management of behavioral problems in children by pooling the evidence from relevant literature that included Level 4 Triple P interventions. Level 4 intervention is indicated if the child has multiple behavior problems in a variety of settings and there are clear deficits in parenting skills. Results indicate that Level 4 of Triple P interventions reduced disruptive behaviors in children. These improvements were maintained well over time, with further improvements in long-term follow-up. These effects support the widespread adoption and implementation of Triple P that is taking place in an increasing number of countries in quite diverse cultural contexts around the world.     

A controlled evaluation of a brief parenting psychoeducation intervention in Burundi

Purpose

Conduct problems and emotional distress have been identified as key problems among children and adolescents in post-war Burundi. This pilot study aims to evaluate the impact of a brief parenting psychoeducation intervention on children’s mental health.

Methods

This study employs a controlled pre and post evaluation design. The two-session psychoeducation intervention was offered to groups of parents of children (mean age 12.3 years, 60.8 % female) who had been screened for elevated psychosocial distress. Children in the intervention group (n = 58) were compared to a waitlist control group (n = 62). Outcome indicators included child-reported levels of aggression (using the Aggression Questionnaire), depression symptoms (using the Depression Self Rating Scale) and perceived family social support.

Results

The intervention had a beneficial effect on reducing conduct problems compared to the control condition (Cohen d = 0.60), especially among boys, while not showing impact on depression symptoms or family social support. Parents evaluated the intervention positively, with increased awareness of positive parenting strategies and appropriate disciplinary techniques reported as the most common learning points.

Conclusion

A brief parenting psychoeducation intervention conducted by lay community counselors is a promising public health strategy in dealing with widespread conduct problems in boys living in violence-affected settings and not so for social and emotional indicators and for girls. An efficacy study is warranted to confirm these preliminary findings.     

The Role of Training Variables in Effective Dissemination of Evidence-Based Parenting Interventions

From a public health perspective, mental health in parents and children can be promoted through population-based dissemination of parenting and family support interventions. However, it is critical that service providers who are acquiring evidence-based parenting interventions complete the training regimen to optimize dissemination and impact. This article examines training completion and its relationship to individual service provider characteristics, barriers to program use and subsequent implementation of an evidence-based program, the Triple P — Positive Parenting Program. In this study, 83.7% of the service providers completed the two-part training. Individual-level variables did not predict training completion. Service providers from diverse backgrounds were equally likely to complete training, were highly satisfied with the training provided and reported relatively few barriers to implementation. The majority of those who completed training (67.6%) went on to deliver the program with families in the community, whereas only 37.8% of those who did not complete training used the program subsequently. Implications are discussed for fidelity in delivery, cost-effectiveness in dissemination efforts, and population-wide health promotion.     

Effects of Cognitive Behavioral Therapy on Daily Living Skills in Children with High-Functioning Autism and Concurrent Anxiety Disorders

CBT is a promising treatment for children with autism spectrum disorders (ASD) and focuses, in part, on children’s independence and self-help skills. In a trial of CBT for anxiety in ASD (Wood et al. in J Child Psychol Psychiatry 50:224–234, 2009), children’s daily living skills and related parental intrusiveness were assessed. Forty children with ASD (7–11 years) and their primary caregiver were randomly assigned to an immediate treatment (IT; n = 17) or 3-month waitlist (WL; n = 23) condition. In comparison to WL, IT parents reported increases in children’s total and personal daily living skills, and reduced involvement in their children’s private daily routines. Reductions correlated with reduced anxiety severity. These results provide preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD.     

Reducing Preschoolers’ Disruptive Behavior in Public with a Brief Parent Discussion Group

This study examined the efficacy of a brief 2-h discussion group for parents of preschool children that show disruptive behavior on shopping trips. Forty-six parents with children aged 2–6 years were randomly assigned to either the intervention condition or a waitlist control group. Significant intervention effects were found for measures of problem child behavior, dysfunctional parenting styles and parents’ confidence in the parenting role. No group differences were found for parental adjustment or conflict over parenting. Intervention gains were maintained at 6-month follow-up. Results are discussed within a primary care and public health framework.     

Behavioural Family Intervention with parents of children with ASD: What do they find useful in the parenting program Stepping Stones Triple P?

This study was conducted in conjunction with a randomised controlled trial of the parenting program Stepping Stones Triple P for parents of children with Autism Spectrum Disorders. The current study concerned examination of the qualitative data arising from the RCT as well as evaluation of the particular parenting strategies that the parents found helpful. The results showed that parents were satisfied with the program, including the partial group format. Further, the majority of participants found the parenting strategies within Stepping Stones Triple P to be helpful, including timeout, physical guidance and blocking. In addition, many of the parents also used the additional strategies of Comic Strip Conversations and Social Stories and the majority of the parents who attempted these strategies found them to be helpful. The clinical implications of the findings are discussed.     

Stress reduction at the work-family interface: positive parenting and self-efficacy as mechanisms of change in Workplace Triple P

Workplace Triple P (WPTP) is a group-based parenting skills training specifically designed to meet the needs of employed parents. Several randomized controlled trials have demonstrated the training's efficacy. This study examined possible mechanisms of change that account for the stress reduction effects of this parenting skills training at the work-family interface. It was hypothesized that reductions in dysfunctional parenting (DP) behavior and increases in parental self-efficacy would mediate the stress-reducing effects of WPTP. The mediator effects were analyzed in a German pre- and postcompleter sample (N = 97 parents; 74 mothers and 23 fathers; treatment condition: n = 42 parents; waitlist-control condition n = 55 parents). The results indicate that individual stress- (IS) level reductions were mediated by decreased levels of DP. In addition, changes in IS levels mediated the effects of the training on work-related stress. The discussion focuses on the importance of understanding mechanisms of change to effectively implement interventions at the work-family interface.     

Do parental attributions affect treatment outcome in a parenting program? An exploration of the effects of parental attributions in an RCT of Stepping Stones Triple P for the ASD population

This study was conducted in conjunction with a randomised controlled trial of the parenting program Stepping Stones Triple P for parents of children with autism spectrum disorders (ASDs). Fifty-nine families with a child with ASD participated. This study focussed upon the role of parental attributions in predicting treatment outcome. Stepping Stones altered parental attributions such that following participation in Stepping Stones parents were significantly less likely to believe that their child's misbehaviour was caused by factors intrinsic to their child and more likely to believe that their child's ASD-related behaviour may change in the future. Parental attributions before the intervention significantly predicted change in the dysfunctional parenting styles over-reactivity and verbosity throughout the intervention. The implications of these findings are discussed in the context of developing a model for the role of parental attributions in predicting treatment outcome.     

Effectiveness of an attachment-focused manualized intervention for parents of teens at risk for aggressive behaviour: The Connect Program

Aggressive, violent and antisocial behaviour in children and adolescents is a growing concern across the globe. Targeting parent-teen relationships is critical in reducing problem behaviour. ‘Connect’ is a manualized ten-week program for parents or alternative caregivers of at-risk teens that focuses on the building blocks of secure attachment: parental sensitivity, cooperation, reflective capacity, and effective dyadic affect regulation. Through didactic and experiential activities, parents develop the competence necessary to identify, understand and respond to the needs of their teen in a manner that provides structure and safety while safeguarding the quality of the parent-teen relationship. In Study 1, twenty parents reported significant increases in perceived parenting satisfaction and efficacy and reductions in adolescents' aggression, antisocial behaviour and other mental health problems following completion of Connect as compared to a waitlist control period. These effects were sustained and additional small effects were noted in decreases in conduct problems, depression and anxiety at a 12-month follow-up. The program was then transported to 17 communities serving 309 parents through standardized training and supervision of group leaders. Study 2 summarizes significant pre- to post-treatment reductions in teen externalizing and internalizing problems; enhanced social functioning; and improvements in affect regulation. Parents also reported significant increases in parenting satisfaction and perceived efficacy and reductions in caregiver burden.     

The international dissemination of evidence-based parenting interventions: impact on practitioner content and process self-efficacy

Implementation of evidence-based parenting programs with parents most in need is important for reducing maladaptive child behavior problems. However, effective implementation is limited by numerous factors including practitioners’ self-efficacy in the delivery of an intervention to a parent, and their lack of confidence in parent consultation skills. This study explores changes in self-efficacy of 5109 practitioners from diverse countries, professional and qualification backgrounds, who received standardized training in the Triple P – Positive Parenting Program between 2007 and 2012. Practitioners were assessed for perceived adequacy of skills and confidence in the delivery of strategies and approaches necessary for the effective delivery of Triple P, pre- and post-training. Results overall confirm that training was associated with significant improvement in both content and process efficacy. While no significant differences in practitioner self-efficacy were found between professional and qualification groups, there were post-training differences between country groups and in practitioners’ sense of competence in consulting with parents about child behavior and appropriate parenting. Implications of these findings are discussed in the context of a growing and diverse health workforce and in developing training protocols that cross different language and regional groups.     

Negative parenting behaviour as a mediator of the effects of telephone-assisted self-help for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder

A previous randomised controlled trial demonstrated the effects of a telephone-assisted self-help (TASH) intervention for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder (ADHD) on ADHD symptoms, oppositional symptoms, functional impairment, and negative parenting behaviour (per-protocol analyses). In the current study, we examined whether changes in positive and negative parenting behaviour mediated the effects on symptoms and impairment. Parents in an enhancement group (n = 51) participated in a 12-month TASH intervention (eight booklets plus up to 14 telephone consultations) as an adjunct to routine clinical care, whereas parents in a waitlist control group (n = 52) received routine clinical care only. Parents completed measures of child symptoms, child functional impairment, and parenting behaviour at baseline, at 6 months, and at 12 months. The mediating effects of parenting behaviour were examined using regression analyses. Per-protocol analyses (n = 74) revealed a significant indirect intervention effect on functional impairment through negative parenting behaviour at 6 months as well as indirect intervention effects on oppositional symptoms and functional impairment through negative parenting behaviour at 12 months. The indirect effect on ADHD symptoms through negative parenting behaviour at 12 months just failed to reach significance. The analyses yielded no indirect intervention effects through positive parenting behaviour. The study provides some, albeit limited, support for the importance of changes in negative parenting behaviour to achieve changes in symptoms and functional impairment during parent training. In consideration of the inconsistent results of previous studies concerning the mediating role of positive and negative parenting behaviour, further research is required to better understand the mechanisms of change during parent training, also including other possible mediators like parenting stress and parental self-efficacy.