Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes

Approximately 15–20 % of children experience behavioral and/or emotional difficulties. Evidence-based treatment will likely not be sufficient to reduce the prevalence of these difficulties in children and adolescents. Effective prevention programs are therefore also needed to enable families access to support at multiple points across the lifecourse. The aim of the current investigation was to evaluate the 4-year efficacy of the group-based Triple P (Positive Parenting Program) as a prevention program administered universally. Seventeen preschools were randomly assigned to Triple P (n?=?11 preschools, 186 families) or a no parenting intervention control group (n?=?6 preschools, 94 families). Long-term efficacy was analyzed with hierarchical linear models using maternal and paternal self-report measures. Mothers and fathers from the intervention preschool group reported significant reductions in dysfunctional parenting behavior (d?=?0.24 and 0.19, respectively). Mothers also reported a less steep decline from pre- to post-intervention in positive parenting behavior, which was maintained 4 years later (d?=?0.38). Fathers from intervention preschools reported a delayed less steep decline in positive parenting during the follow-up (d?=?0.33). In addition, mothers from intervention preschools reported immediate improvement in child behavior problems during the program while mothers from control preschools did not report this immediate change. However, with mothers from intervention preschools reporting more child behavior problems at baseline, the effect disappeared by the fourth year (d?=?0.19). The results support the long-term efficacy of the Triple P-group program as a universal prevention intervention for changing parenting behavior while there was little evidence for maintenance of change in behavior problems.     

Web-Based Prevention of Parenting Difficulties in Young,Urban Mothers Enrolled in Post-Secondary Education

Research consistently indicates that young mothers are at elevated risk for adverse social and economic risks. Recent attention has been paid to the value of maternal educational attainment for their children’s economic and social outcomes. Pursuit of post-secondary education requires mothers to balance multiple roles, potentially stressing the parent–child relationship. Yet, almost no studies have addressed parenting and associated stress in young mothers enrolled in post-secondary education, and no preventive intervention trials have been conducted. We screened young mothers (<25 years at child’s birth) pursuing post-secondary education in an urban, inner city college for study inclusion based on elevated parenting stress, and participated in a randomized controlled trial to assess the efficacy of a web-based parenting intervention (Triple P Online) in reducing parenting stress and dysfunctional discipline (N = 52). Mothers were randomly assigned to the web-based parenting program condition or to a waitlist control condition. Mothers who completed at least the first four core modules of the online program had lower scores on the Parenting Scale’s subscales (Overreactivity, Verbosity, and Laxness), compared to those who did not complete four or more modules. No intervention effects were obtained for parenting stress. The current study provides preliminary evidence of the efficacy of this online parenting program for reducing risk for dysfunctional discipline in student mothers. Future research is warranted to replicate these findings, and to test whether provision of supplemental support for implementation, or briefer program formats may promote both program compliance and outcomes related to reducing parenting stress.     

Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial

The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P—Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.     

History of Maltreatment in Childhood and Subsequent Parenting Stress in At-Risk,First-Time Mothers: Identifying Points of Intervention During Home Visiting

Home visiting is an effective preventive intervention that can improve parenting outcomes for at-risk, new mothers, thereby optimizing subsequent child development. A history of maltreatment in childhood is common in mothers participating in home visiting, yet the extent to which such a history is related to parenting outcomes during home visiting is unknown. The current study evaluated whether mothers with a history of maltreatment in childhood respond less favorably to home visiting by examining the direct and indirect pathways to subsequent parenting stress, a key parenting outcome affecting child development. First-time mothers (N?=?220; age range?=?16–42) participating in one of two home visiting programs, Healthy Families America or Nurse Family Partnership, were evaluated at enrollment and again at 9-and 18-month post-enrollment assessments. Researchers administered measures of maternal history of maltreatment in childhood, depressive symptoms, social support, and parenting stress. Maternal history of maltreatment in childhood predicted worsening parenting stress at the 18-month assessment. Mediation modeling identified two indirect pathways, one involving social support at enrollment and one involving persistent depressive symptoms during home visiting, that explained the relation between a history of maltreatment in childhood and parenting stress at the 18-month assessment. Ways to improve the preventive effects of home visiting for mothers with a history of maltreatment in childhood through the identification of relevant intervention targets and their ideal time of administration are discussed.     

Parenting knowledge and its role in the prediction of dysfunctional parenting and disruptive child behaviour

Background   There is a paucity of research on the relationship between parental knowledge, parenting and parenting self-efficacy, and some inconsistencies have been reported in the literature.
Method   Parent knowledge of effective parenting strategies was assessed among 68 parents from a non-clinic sample, who also completed questionnaires relating to parenting confidence, quality of parenting and child behaviour.
Results   Parents with greater knowledge tended to be less dysfunctional, and reported significantly higher education and income levels. Parenting confidence explained a significant proportion of the variance in reported frequency of disruptive child behaviour while knowledge did not independently contribute to the prediction. However, the relationship between parenting confidence and dysfunctional parenting was moderated by the level of knowledge. There was a stronger negative relationship between confidence and dysfunctional parenting when knowledge level was low than when it was high. Post hoc analyses indicated that the relationship between parenting knowledge and disruptive child behaviour was moderated by the level of parenting dysfunction. Parenting knowledge and reported frequency of disruptive behaviour were positively related when the level of dysfunction was low, but were unrelated when it was high.
Conclusions   Parents with low levels of knowledge and confidence in their parenting may be at greater risk of dysfunctional parenting and might benefit from interventions designed to enhance both knowledge and confidence. Results are interpreted in relation to inconsistencies with previous research and implications for future methodologies.     

Population-Based Provider Engagement in Delivery of Evidence-Based Parenting Interventions: Challenges and Solutions

Population-wide interventions do not often address parenting, and relatively little is known about large scale dissemination of evidence-based parenting interventions. Most parenting interventions are not designed to reach the majority of parents in a geographic area or to influence prevalence rates for a problem, nor do they take full advantage of the existing workforce. Implementation of parenting interventions on this scale is a complex process; examination of such efforts can inform both research and policy. The US Triple P System Population Trial, designed to reduce child maltreatment at a population level, affords a unique opportunity to examine the steps involved in launching positive parenting support at a population level via an existing provider workforce. The implementation process is described; challenges and solutions are discussed.     

Addendum to “Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes”

A previous article published in Prevention Science 3 years ago (Heinrichs et al. 2014) presented the results of a randomized controlled trial of the Triple P group program 4 years (FU4) after administration as a universal prevention approach in preschools. The present addendum resolves inconsistencies in outcome reporting (e.g., total scores of scales versus subscale scores) and provides information on measures that were additionally available to analyze further potential effects of the intervention. Effects in secondary outcome domains not reported in Heinrichs et al. (2014) are furthermore analyzed and reported. The original data analyses were varied using a different statistical model in this addendum. Re-analyses supported the original results, including changes in self-reported maternal and paternal positive parenting, in maternal dysfunctional parenting behavior as well as in maternal reports of child behavior. In addition, when analyzing the externalizing and internalizing dimensions, analysis revealed a statistically significant change in externalizing but not internalizing child symptoms. No significant intervention effects were found for secondary outcome domains. Considering important limitations in the study design [such as baseline differences at pre-assessment with mothers from intervention preschools reporting more child behavioral problems prior to introducing the intervention and predominantly non-significant effects from (a) fathers perspective, (b) teacher ratings at 1-year follow up (FU1), and (c) behavioral observations at FU1], we believe that this trial alone cannot be taken as sufficient evidence for a significant and meaningful change in child behavioral problems, which is the ultimate goal of child prevention programs. Therefore, future studies need to replicate and extend upon these results by including larger sample sizes and overcome the discussed limitations.     

Parenting Wisely Six Months Later: How Implementation Delivery Impacts Program Effects at Follow-Up

We evaluated the effectiveness of the Parenting Wisely (PW) program 6 months post intervention and assessed differences based on delivery format. Using a quasi-experimental design, parents (N = 311) participated in the PW program in one of five formats (i.e., parents-only intensive workshop, parents-only 5-week group, parents and adolescents 5-week group, parent and adolescent online, and parent-only online format). An additional 53 parents served as a comparison group. We used the McMaster Family Assessment Device, the Child Behavior Checklist, and the Violent Behavior Checklist to measure family functioning, parenting, and adolescent behavior. Relative to the comparison group, at 6 month follow-up parents who participated in PW reported increases in confidence in their parenting skills, decreases in conflicts with their adolescents, and decreases in adolescent externalizing and violent behavior. Mechanisms of change analyses supported the conceptual model that program effects were related to child behavior changes by influencing positive parenting and decreasing negative family dynamics. PW effectiveness did not vary substantially by delivery format, except for the intensive workshop format, which was less effective than other formats. These findings extend research on PW to include evidence of sustained program effects on adolescent externalizing and violent behaviors in an ethnically diverse, socioeconomically disadvantaged sample. Study findings are relevant to agencies and clinicians who are seeking to implement an evidence-based, flexible parent-training program.     

The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants’ health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel “empowered” after 12 weeks compared to initially feeling “out of control” with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.     

Effects of an evidence-based parenting program on biobehavioral stress among at-risk mothers for child maltreatment: A pilot study

ABSTRACT

Parental stress is an important risk factor for child maltreatment (CM) perpetration. Evidence-based, parent-training programs can decrease CM perpetration risk and reduce self-reported parental stress; however, little is known about how such programs impact physiological stress correlates. In this quasi-experimental pilot study, maternal biobehavioral responses were measured in response to SafeCare®, an evidence-based program targeting CM, often implemented by social workers in child welfare settings. Maternal participants (N = 18) were recruited to complete SafeCare and repeated within-subject assessments pre- and post-intervention. Analyses examined associations between self-reported parental stress and mental health symptomology with stress markers for cortisol, alpha-amylase, and dihydroepiandrosterone at baseline and follow-up. Baseline correlation analyses showed strong associations between parental stress, salivary cortisol levels, and alpha-amylase. At follow-up, significant correlations were found between parental stress and alpha-amylase for intervention completers (n = 7). Completers on average exhibited decreases across self-reported parental stress and global distress symptomology and improvements in salivary cortisol and alpha-amylase levels. Participants with impaired cortisol levels at baseline were within normal limits post-intervention. These pilot findings suggest that salivary cortisol and alpha-amylase are compelling physiological correlates of parental stress among high-risk parents. Results also support short-term, positive effects of SafeCare in potentially regulating physiological stress systems among at-risk mothers.     

Which Risk Factors for Child Maltreatment Predict Mothers’ Enrollment in a Parenting Support Program?

Parenting support programs are an effective means of preventing child maltreatment. However, these programs are often criticized for their limited ability to enroll and engage the parents who need them most. The present study aimed to determine which risk factors associated with child maltreatment predicted mothers’ enrollment in the Triple P—Positive Parenting Program in Quebec. To this end, 240 mothers of children aged 6 months to 8 years enrolled in Triple P were compared with 834 mothers randomly selected from the general population. The results suggest that mothers who perceived their child to be more difficult, used fewer positive parenting practices, and reported a lower parenting sense of competence were more likely to enroll in the program. Being unemployed, having a lower income, and being a single parent or part of a stepfamily also increased the mothers’ likelihood of participating in Triple P. These results suggest that Triple P was implemented in such a way as to attract families presenting various risk factors, which is promising in a child maltreatment prevention context.

     

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms

Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance = 3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.     

Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

Background

The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children.

Objective

The aim of the current study was to observe the pedagogical interventions of group care workers within residential youth care and their associations with child behaviors.

Methods

Group care worker interventions and child behaviors were videotaped during structured observations. Participants included 95 children (64 % boys, M _age = 9.19) and 53 group care workers (74 % female, M _age = 33.79 years). A coding system was developed to code pedagogical interventions and child behaviors.

Results

It showed that group care workers mainly used positive pedagogical interventions (warmth/support and positive control) and seldom used negative pedagogical interventions (permissiveness and negative control). Frustration and anger of children was associated with positive controlling interventions and permissiveness of group care workers. The hypothesis that child anxiety and nervousness is associated with warm and supportive interventions could not be confirmed.

Conclusions

Pedagogical interventions should be part of education, training, and supervision of group care workers.     

Te Whānau Pou Toru: a Randomized Controlled Trial (RCT) of a Culturally Adapted Low-Intensity Variant of the Triple P-Positive Parenting Program for Indigenous Māori Families in New Zealand

Evidence-based parenting support programs (EBPS) based on social learning and cognitive behavioral principles are effective in reducing conduct-related problems in a diverse range of cultural contexts. However, much less is known about their effects with indigenous families. A Collaborative Participation Adaptation Model (CPAM) was used to culturally adapt a low-intensity, two-session group variant of the Triple P-Positive Parenting Program for Māori parents of young children in New Zealand. CPAM involved collaborating closely with Māori tribal elders, practitioners as end-users, and parents as consumers through a participatory process to identify content and delivery process used in Triple P that would ensure that traditional Māori cultural values were incorporated. The culturally adapted program (Te Whānau Pou Toru) was then evaluated with 70 parents of 3–7-year-old children in a two-arm randomized clinical trial (intervention vs waitlist control). Results showed that parents in the intervention group reported significantly greater improvements in child behavior problems and reduced interparental conflict about child-rearing compared to parents in the control group at immediate post-intervention. These intervention effects were either maintained or improved further at follow-up assessment. At 6-month follow-up intervention-group parents reported significantly greater reductions in overreactive parenting practices and greater confidence in managing a range of difficult child behaviors than control parents. The culturally adapted program was associated with high levels of parental satisfaction. Findings are discussed in terms of making brief, effective, culturally adapted parenting support available to Māori families.     

Piloting Lead with Love: A Film-Based Intervention to Improve Parents’ Responses to Their Lesbian, Gay, and Bisexual Children

Lesbian, gay, and bisexual youth are at increased risk for a variety of poor health outcomes, relative to their heterosexual counterparts, and recent research implicates family responses to a child’s sexual orientation as an important predictor of these health difficulties. Lead with Love is a 35-min documentary-style preventive intervention created to improve parents’ behaviors toward their lesbian, gay, and bisexual (LGB) children, by providing parents with support, information, and concrete behavioral guidance. The film was made available free online, and was promoted widely with a multi-media marketing campaign. In this paper we describe the theoretical and empirical rationale for the intervention, and report findings from pilot data collected in the first year after the film’s release. Specifically, we gathered data to examine the feasibility of reaching parents of LGB youth with this intervention, to determine whether it was acceptable, and to provide preliminary indicators of its potential efficacy. In the first 12 months after launch, 10,949 individuals viewed the film online. The film successfully reached parents of LGB youth (n = 1,865), including the hardest to reach parents: 21 % had only learned about their child’s sexual orientation in the past month, 36 % reported having an LGB child was “very” or “extremely” hard for them, and 86 % had never obtained any other formal support for having an LGB child. Parents who completed a follow-up assessment immediately after the film reported significant pre- to post-film increases in self-efficacy for parenting an LGB child.     

Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta‐Analysis

Abstract: Triple P is a parenting program intended to prevent and to provide treatment for severe behavioral, emotional, and developmental problems in children. The aim of this meta‐analysis was to assess the effectiveness of Triple P Level 4 interventions on parenting styles and parental competency. Level 4 is an intensive training program of 8 – 10 sessions for parents of children with more severe behavioral difficulties. The results indicated that the Triple P Level 4 interventions reduced dysfunctional parenting styles in parents and also improved parental competency. These effects were maintained well through time and appear to support the widespread adoption and implementation of Triple P Level 4 interventions that is taking place in an increasing number of countries around the world.     

Mental Vitality @ Work: The effectiveness of a mental module for workers’ health surveillance for nurses and allied health professionals,comparing two approaches in a cluster-randomised controlled trial

Purpose

The aim of this study was to compare two approaches for a worker’s health surveillance (WHS) mental module on work functioning and work-related mental health.

Methods

Nurses and allied health professionals from one organisation were cluster-randomised at ward level to e-mental health care (EMH) (N = 579) or occupational physician care (OP) (N = 591). Both groups received screening and personalised feedback on impaired work functioning and mental health. Positively screened participants received an invitation to follow a self-help EMH intervention, or for a consultation with an OP. The primary outcome was impaired work functioning. Follow-up was performed after 3 and 6 months. Linear mixed models were applied to determine differences. Non-inferiority of the EMH-care approach was demonstrated if the mean absolute improvement on work functioning in the OP-care group was ≤10 points higher than the EMH-care group.

Results

Analyses were performed on the positively screened participants (almost 80 %) (EMH N = 75; OP N = 108) and all participants (EMH N = 98; OP N = 142). Both groups improved over time regarding impaired work functioning. A considerable percentage of participants had improved relevantly at follow-up regarding work functioning (3 months: EMH 30 %, OP 46 %; 6 months: EMH 36 %, OP 41 %) compared to baseline. No statistically significant differences were found between the groups, and the difference did not exceed the pre-defined criterion for non-inferiority.

Conclusion

The OP-care approach for a WHS mental module trended towards better performance in targeting work functioning, but our findings indicate that the EMH-care approach was non-inferior. However, the high dropout rate and low compliance to EMH interventions should be taken into account.     

Evaluation of ‘The Father Effect’ Media Campaign to Increase Awareness of,and Participation in,an Online Father-Inclusive Parenting Program

ABSTRACT

There is substantial evidence that parenting programs are effective in improving parenting and child mental health outcomes. While there is increasing focus on delivering parenting interventions online to increase their reach and dissemination, fathers are underrepresented in all formats of parenting programs. However, research suggests that father participation is important for intervention effectiveness. This study evaluated the effectiveness of a media campaign for increasing awareness of, and participation in, an online father-inclusive parenting program called ‘ParentWorks’. An 8-week campaign was conducted in Australia via social media channels, digital display advertising, digital television, and radio. To assess the impact of the campaign, data were obtained from caregivers registering for ParentWorks during the campaign period (n = 848) and an 8-week comparison period that occurred 3 months later (n = 254). Additionally, a nationally representative sample of 2021 caregivers of children aged 2–16 years completed an online survey. Survey questions asked about exposure to the campaign, registration for participation in ParentWorks, and knowledge of the importance of father participation in parenting programs. Three times as many caregivers registered during the 8-week media campaign compared to the comparison period, and a significantly greater proportion of male caregivers registered in the campaign versus the comparison period. The online survey found that 11% of caregivers reported exposure to the campaign, and significantly more fathers than mothers reported exposure. Results showed that those who were exposed to the campaign were significantly more likely to endorse the importance of father participation in parenting programs, than those not exposed to the campaign. The findings indicate that media campaigns appear to be an effective method of increasing awareness of online parenting programs and enhancing rates of father involvement.