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Tuntipuchitanon S, Kangwanthiti IO, Jirakran K, Trairatvorakul P, Chonchaiya W. Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial. Sci Rep 2024; 14:20001. [PMID: 39198492 PMCID: PMC11358410 DOI: 10.1038/s41598-024-70842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency. Clinical Trial Registration: Thai Clinical Trials Registry ( https://www.thaiclinicaltrials.org/ ); TCTR20201030001 on 30/10/2020.
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Affiliation(s)
- Sararat Tuntipuchitanon
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ing-On Kangwanthiti
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ketsupar Jirakran
- Center of Excellence for Maximizing Children's Developmental Potential, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th Floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pon Trairatvorakul
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Center of Excellence for Maximizing Children's Developmental Potential, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th Floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Weerasak Chonchaiya
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Maximizing Children's Developmental Potential, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th Floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
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Featherston R, Barlow J, Song Y, Haysom Z, Loy B, Tufford L, Shlonsky A. Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents. Cochrane Database Syst Rev 2024; 1:CD012445. [PMID: 38197473 PMCID: PMC10777456 DOI: 10.1002/14651858.cd012445.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Emotional and behavioural difficulties (EBD) in children are common, characterised by externalising or internalising behaviours that can be highly stable over time. EBD are an important cause of functional disability in childhood, and predictive of poorer psychosocial, academic, and occupational functioning into adolescence and adulthood. The prevalence, stability, and long-term consequences of EBD highlight the importance of intervening in childhood when behavioural patterns are more easily modified. Multiple factors contribute to the aetiology of EBD in children, and parenting plays an important role. The relationship between parenting and EBD has been described as bidirectional, with parents and children shaping one another's behaviour. One consequence of bidirectionality is that parents with insufficient parenting skills may become involved in increasingly negative behaviours when dealing with non-compliance in children. This can have a cyclical effect, exacerbating child behavioural difficulties and further increasing parental distress. Behavioural or skills-based parenting training can be highly effective in addressing EBD in children. However, emotional dysregulation may intercept some parents' ability to implement parenting skills, and there is recognition that skills-based interventions may benefit from adjunct components that better target parental emotional responses. Mindful parenting interventions have demonstrated some efficacy in improving child outcomes via improvements in parental emotion regulation, and there is potential for mindfulness training to enhance the effectiveness of standard parent training programmes. OBJECTIVES To assess the effectiveness of mindfulness-enhanced parent training programmes on the psychosocial functioning of children (aged 0 to 18 years) and their parents. SEARCH METHODS We searched the following databases up to April 2023: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL Plus, PsycINFO, Sociological Abstracts, Social Sciences Citation Index, Conference Proceedings Citation Index - Social Science & Humanities, AMED, ERIC, ProQuest Dissertations & Theses, Cochrane Database of Systematic Reviews, Campbell Collaboration Library of Systematic Reviews, as well as the following trials registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also contacted organisations/experts in the field. SELECTION CRITERIA We included randomised and quasi-randomised trials. Participants were parents or caregivers of children under the age of 18. The intervention was mindfulness-enhanced parent training programmes compared with a no-intervention, waitlist, or attentional control, or a parent training programme with no mindfulness component. The intervention must have combined mindfulness parent training with behavioural or skills-based parent training. We defined parent training programmes in terms of the delivery of a standardised and manualised intervention over a specified and limited period, on a one-to-one or group-basis, with a well-defined mindfulness component. The mindfulness component must have included mindfulness training (breath, visualisation, listening, or other sensory focus) and an explicit focus on present-focused attention and non-judgemental acceptance. DATA COLLECTION AND ANALYSIS We followed standard Cochrane procedures. MAIN RESULTS Eleven studies met our inclusion criteria, including one ongoing study. The studies compared a mindfulness-enhanced parent training programme with a no-treatment, waitlist, or attentional control (2 studies); a parent training programme with no mindfulness component (5 studies); both a no-treatment, waitlist, or attentional control and a parent training programme with no mindfulness component (4 studies). We assessed all studies as being at an unclear or high risk of bias across multiple domains. We pooled child and parent outcome data from 2118 participants to produce effect estimates. No study explicitly reported on self-compassion, and no adverse effects were reported in any of the studies. Mindfulness-enhanced parent training programmes compared to a no-treatment, waitlist, or attentional control Very low certainty evidence suggests there may be a small to moderate postintervention improvement in child emotional and behavioural adjustment (standardised mean difference (SMD) -0.46, 95% confidence interval (CI) -0.96 to 0.03; P = 0.06, I2 = 62%; 3 studies, 270 participants); a small improvement in parenting skills (SMD 0.22, 95% CI 0.06 to 0.39; P = 0.008, I2 = 0%; 3 studies, 587 participants); and a moderate decrease in parental depression or anxiety (SMD -0.50, 95% CI -0.96 to -0.04; P = 0.03; 1 study, 75 participants). There may also be a moderate to large decrease in parenting stress (SMD -0.79, 95% CI -1.80 to 0.23; P = 0.13, I2 = 82%; 2 studies, 112 participants) and a small improvement in parent mindfulness (SMD 0.21, 95% CI -0.14 to 0.56; P = 0.24, I2 = 69%; 3 studies, 515 participants), but we were not able to exclude little to no effect for these outcomes. Mindfulness-enhanced parent training programmes compared to parent training with no mindfulness component Very low certainty evidence suggests there may be little to no difference postintervention in child emotional and behavioural adjustment (SMD -0.09, 95% CI -0.58 to 0.40; P = 0.71, I2 = 64%; 5 studies, 203 participants); parenting skills (SMD 0.13, 95% CI -0.16 to 0.42; P = 0.37, I2 = 16%; 3 studies, 319 participants); and parent mindfulness (SMD 0.11, 95% CI -0.19 to 0.41; P = 0.48, I2 = 44%; 4 studies, 412 participants). There may be a slight decrease in parental depression or anxiety (SMD -0.24, 95% CI -0.83 to 0.34; P = 0.41; 1 study, 45 participants; very low certainty evidence), though we cannot exclude little to no effect, and a moderate decrease in parenting stress (SMD -0.51, 95% CI -0.84 to -0.18; P = 0.002, I2 = 2%; 3 studies, 150 participants; low certainty evidence). AUTHORS' CONCLUSIONS Mindfulness-enhanced parenting training may improve some parent and child outcomes, with no studies reporting adverse effects. Evidence for the added value of mindfulness training to skills-based parenting training programmes is suggestive at present, with moderate reductions in parenting stress. Given the very low to low certainty evidence reviewed here, these estimates will likely change as more high-quality studies are produced.
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Affiliation(s)
- Rebecca Featherston
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University, Caulfield, Australia
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Yunshan Song
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University, Caulfield, Australia
| | - Zoe Haysom
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University, Caulfield, Australia
| | - Brenda Loy
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University, Caulfield, Australia
| | - Lea Tufford
- School of Nursing and Allied Health Professions, Laurentian University, Ontario, Canada
| | - Aron Shlonsky
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University, Caulfield, Australia
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Studts CR, Jacobs JA, Bush ML, Lowman J, Westgate PM, Creel LM. Behavioral Parent Training for Families With Young Deaf or Hard of Hearing Children Followed in Hearing Health Care. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3646-3660. [PMID: 35985319 PMCID: PMC9802658 DOI: 10.1044/2022_jslhr-22-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE It is well established that individuals with a communication disability, including being deaf or hard of hearing (DHH), experience inequities in health services and outcomes. These inequities extend to DHH children's access to psychosocial evidence-based interventions (EBIs). Behavioral parent training is an EBI that can be used to improve caregiver and child outcomes. Despite being supported by decades of effectiveness research, this EBI is rarely accessed by, or studied with, caregivers of DHH children. The purpose of this article is to describe a program of stakeholder-engaged research adapting and assessing behavioral parent training with caregivers of young DHH children followed in hearing health care, aimed at reducing inequities in access to this EBI. METHOD The first section briefly summarizes the literature on disruptive behavior problems in young children, with a focus on preschool-age DHH children. The evidence base for behavioral parent training is described. Next, the gaps in knowledge and practice regarding disruptive behaviors among DHH children are highlighted, and the potential integration of behavioral parent training into the standard of care for this population is proposed. CONCLUSIONS Young DHH children who use hearing aids and/or cochlear implants experience disruptive behavior problems at rates at least as high as typically hearing children, but their access to EBIs is limited, and behavioral parent training programs tailored to this population have not been rigorously tested. Caregivers and hearing health care service providers affirm the potential benefits of behavioral parent training and were partners in adapting this EBI. This research highlights several principles and approaches essential for reducing inequities and improving the quality of life not only for DHH children and their families but also for individuals with communication disabilities more broadly: engagement of key stakeholders in research, collaboration across disciplines, and using implementation science methods and models to design for implementation, dissemination, and sustainment. Presentation Video: https://doi.org/10.23641/asha.21215900.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Julie A. Jacobs
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Matthew L. Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | | | - Liza M. Creel
- Department of Health Management and Systems Sciences, University of Louisville, KY
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Sethi A, O'Brien S, Blair J, Viding E, Mehta M, Ecker C, Blackwood N, Doolan M, Catani M, Scott S, Murphy DGM, Craig MC. Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent Training. Biol Psychiatry 2022:S0006-3223(22)01658-4. [PMID: 36642564 DOI: 10.1016/j.biopsych.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Parenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person's fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. METHODS We conducted a prospective, case-control study of boys with CPs and typically developing (TD) boys. Both groups (ages 5-10 years) completed 2 magnetic resonance imaging sessions (18 ± 5.8 weeks apart) with ASB assessed at each visit. Participants included boys with CPs following referral to a parenting intervention group and TD boys recruited from the same schools and geographical regions. Final functional magnetic resonance imaging data were available for 36 TD boys and 57 boys with CPs. Boys with CPs were divided into those whose ASB improved (n = 27) or persisted (n = 30) following the intervention. Functional magnetic resonance imaging data assessing fear reactivity were then analyzed using a longitudinal group (TD/improving CPs/persistent CPs) × time point (pre/post) design. RESULTS Amygdala hypoactivity to fear was observed only in boys with CPs who had persistent ASB and was absent in those whose ASB improved following intervention. CONCLUSIONS Our findings suggest that amygdala hypoactivity to fear is a marker for ASB that is resistant to change following a parenting intervention and a putative target for future treatments.
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Affiliation(s)
- Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suzanne O'Brien
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. suzanne.o'
| | - James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Copenhagen, Capital Region of Denmark, Denmark
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Mitul Mehta
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Christine Ecker
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Moira Doolan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Catani
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Female Hormone Clinic Maudsley Hospital, London, United Kingdom; National Autism Unit, Bethlem Royal Hospital, London, United Kingdom
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Studts CR, Jacobs JA, Bush ML, Lowman J, Creel LM, Westgate PM. Study Protocol: Type 1 Hybrid Effectiveness-Implementation Trial of a Behavioral Parent Training Intervention for Parents of Young Children Who Are Deaf or Hard of Hearing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1163-1178. [PMID: 35316091 PMCID: PMC9567338 DOI: 10.1044/2022_ajslp-21-00186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/10/2021] [Accepted: 01/01/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Children who are deaf or hard of hearing (DHH) and who use hearing aids or cochlear implants are more likely than their peers with typical hearing to exhibit behavior problems. Although multiple evidence-based interventions for child behavior problems exist, they are rarely delivered to children who are DHH, and no rigorous randomized controlled trials have been conducted to determine their effects with this population. This protocol describes a study aiming to test the effectiveness of an evidence-based behavioral parent training intervention adapted for parents of young children who are DHH and simultaneously to assess key implementation outcomes and multilevel contextual factors influencing implementation. METHOD The protocol for a Type 1 hybrid effectiveness-implementation trial of a behavioral parent training intervention for parents of young children who are DHH is presented, including details of the study design, participants, assessments, and analyses. Using a stakeholder-engaged, mixed-methods approach, we will test the effects of the intervention versus treatment as usual on parenting behaviors, child behaviors, and a range of secondary effectiveness outcomes, including adherence to using hearing aids and cochlear implants as well as measures of child speech and language. We will assess the acceptability, feasibility, fidelity, and costs of the intervention from the perspectives of peer coaches who deliver the intervention, hearing health care clinicians (including audiologists and speech-language pathologists), and administrators of programs serving young children who are DHH. CONCLUSIONS Results of this trial will inform future efforts to close the gap between prevalence of behavioral problems in young children who are DHH and access to and use of evidence-based interventions to prevent and treat them. If effective, this intervention could be widely implemented using strategies informed by the findings of this study to benefit young children who are DHH and followed in hearing health care and their families.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Julie A. Jacobs
- Department of Otolaryngology–Head & Neck Surgery, University of Kentucky, Lexington
| | - Matthew L. Bush
- Department of Otolaryngology–Head & Neck Surgery, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Liza M. Creel
- Department of Health Management and Systems Sciences, University of Louisville, KY
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Tuntipuchitanon S, Kangwanthiti IO, Jirakran K, Trairatvorakul P, Chonchaiya W. Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial. Sci Rep 2022; 12:6420. [PMID: 35440798 PMCID: PMC9017087 DOI: 10.1038/s41598-022-10193-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency.Clinical trial registration Thai Clinical Trials Registry; https://www.thaiclinicaltrials.org/ ; TCTR20201030001; October 30, 2020.
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Affiliation(s)
- Sararat Tuntipuchitanon
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ing-On Kangwanthiti
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ketsupar Jirakran
- Maximizing Thai Children's Developmental Potential Research Unit, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pon Trairatvorakul
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Maximizing Thai Children's Developmental Potential Research Unit, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Weerasak Chonchaiya
- Division of Growth and Development, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Maximizing Thai Children's Developmental Potential Research Unit, Division of Growth and Development, Department of Paediatrics, Sor Kor Building, 11th floor, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
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Till AC, Florquin R, Delhaye M, Kornreich C, Williams DR, Briganti G. A network perspective on abnormal child behavior in primary school students. Psychol Rep 2022:332941221077907. [PMID: 35331028 DOI: 10.1177/00332941221077907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abnormal child behavior is a complex entity including among others disorders such as ADHD, a neuropsychiatric disorder interfering with the normal development of the child, and combining many comorbidities. There are no specific tools designed to assess abnormal child behavior, although well-known ADHD screening tools such as the CTRS-R:S go beyond the disorder itself and cover the wider construct. This can be understood as the complex system of mutually influencing entities, that is why the aim of this study was to investigate the items of the CTRS-R:S as a psychological network. We analyzed a data set of 525 children in French-speaking primary schools from Belgium, and estimated a Bayesian Gaussian Graphical Model with a Bayes Factor of 30. We identified highly connected nodes from each community of the CTRS-R:S to build an additional network of communities. In the domain network, Oppositional and Cognitive skills share the strongest connection in the network. The 28-item network was overall positively connected albeit the presence of some negative connections. The spinglass algorithm identified eight domains in the CTRS-R:S network that causally influence each other. The network approach is a useful framework to investigate the domains of abnormal child behavior as well as the interplay between individual symptoms.
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Affiliation(s)
- Apolline C Till
- Department of Child Psychiatry, Hôpital Erasme, 26659Université Libre de Bruxelles, Brussels, Belgium
| | - Rémi Florquin
- Faculté de Médecine, 26659Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Delhaye
- Department of Child Psychiatry, Hôpital Erasme, 26659Université Libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et Addictologie, 26659Université Libre de Bruxelles, Brussels, Belgium
| | | | - Giovanni Briganti
- Laboratoire de Psychologie Médicale et Addictologie, Faculty of Medicine, 26659Université libre de Bruxelles, Brussels; and Department of Psychology, Harvard University, Cambridge, MA, USA
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The Efficacy of Parent Training Interventions for Disruptive Behavior Disorders in Treating Untargeted Comorbid Internalizing Symptoms in Children and Adolescents: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:542-552. [PMID: 33991282 PMCID: PMC8324591 DOI: 10.1007/s10567-021-00349-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/17/2022]
Abstract
Disruptive behavior disorders (DBDs) are among the primary reasons for child and youth referrals to mental health services and are linked to poor adult outcomes including antisocial behavior disorder. Research indicates a high incidence of internalizing problems in those with DBDs and those who have DBDs with cooccurring internalizing problems may have more severe later outcomes. Interventions targeted at internalizing symptoms have been found to also reduce comorbid externalizing problems. The impact of treatments for DBDs on comorbid internalizing disorders is not known. Databases PsycINFO, EMBASE and MEDLINE were systematically searched based on the Cochrane guidelines for systematic reviews. Records were independently reviewed by two reviewers. 12 papers were deemed eligible. A quality assessment of the selected studies was conducted independently by both reviewers. The 12 studies included 1334 young people with a mean age of 5 years. The parent training interventions assessed were the Incredible Years (6/12 studies), Triple-P (5/12) and Tuning In To Kids (1/12). 11 of the 12 studies reported significant reductions in primary externalizing behavior problems and DBDs. 7 studies reported significant reductions in internalizing symptoms. Mechanisms of change, clinical implications and directions for future research are discussed.
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Arkan B, Güvenir T, Ralph A, Day J. The efficacy and acceptability of the Triple P: Positive Parenting Program with Turkish parents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:148-156. [PMID: 32578258 DOI: 10.1111/jcap.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effectiveness of Group Teen Triple P with parents who have behaviorally disturbed adolescents. METHODS The research was conducted in an experimental manner. The sample was 76 parents who were grouped as 38 cases and 38 controls with a block randomization method. Data were collected using the Family Background Questionnaire, General Health Questionnaire (GHQ-12), Strengths and Difficulties Questionnaire (SDQ), Conflict Behavior Questionnaire (CBQ), and Parent Satisfaction Questionnaire. Group Teen Triple P Program was implemented with the case group for 8 weeks. Data were collected immediately after the program and again after 3 months. Data were evaluated using variance analysis, t test, χ2 test, multivariate analysis of covariance, and analysis of covariance test. RESULTS It was found that participation in Group Teen Triple P resulted in the improvement of parental mental health, decreased problematic behavior of the adolescents, and fewer problems between adolescents and their parents. CONCLUSION Group Teen Triple P should be made available to more parents of adolescents in Turkey.
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Affiliation(s)
- Burcu Arkan
- Psychiatric Nursing Department, Faculty of Health Sciences, Uludag University, Bursa, Turkey
| | - Taner Güvenir
- Child Psychiatry Department, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Alan Ralph
- The Queensland University Schools of Psychology, Brisbane, Queensland, Australia
| | - Jamin Day
- The Queensland University Schools of Psychology, Brisbane, Queensland, Australia
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Eisenhower A, Taylor H, Baker BL. Starting Strong: A School-Based Indicated Prevention Program During the Transition to Kindergarten. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr45-2.141-170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ristkari T, Mishina K, Lehtola MM, Sourander A, Kurki M. Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet-based parent training programme. Scand J Caring Sci 2019; 34:420-427. [PMID: 31487074 PMCID: PMC7328683 DOI: 10.1111/scs.12744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/23/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems. AIM To describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four-year-old children and an Internet-based parent training programme with telephone coaching. METHODS This is a descriptive, cross-sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open-ended question were analysed using inductive content analysis. RESULTS The experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet-based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies. CONCLUSION Within primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.
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Affiliation(s)
- Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Treatment of child externalizing behavior problems: a comprehensive review and meta-meta-analysis on effects of parent-based interventions on parental characteristics. Eur Child Adolesc Psychiatry 2019; 28:1025-1036. [PMID: 29948228 DOI: 10.1007/s00787-018-1175-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/23/2018] [Indexed: 11/25/2022]
Abstract
This is the first meta-meta-analysis examining the effects of parent-based interventions for children with externalizing behavior problems on parental characteristics (parenting, parental perceptions, parental mental health, parental relationship quality). Parent training interventions are recognized as evidence-based interventions for the treatment of externalizing behavior problems, although meta-analytic effects are heterogeneous. The objective of the present study was to comprehensively combine meta-analytic results on parent training interventions to arrive at valid effect predictions. Electronic databases were searched (PsycINFO, Medline, PubMed). In total, 11 meta-analyses were included that mainly comprised parents of children under the age of 13 years. Analyses were based on random effects models. Effect estimates were transformed to standardized mean differences (SMD) and corrected for primary study overlap. Results revealed a significant moderate overall effect for parenting (SMD 0.53) as well as for parents' report of parenting (SMD 0.60) and parental perceptions (SMD 0.52). Effects remained stable to follow-up. Results for observational data, parental mental health and parental relationship quality were small and only partially significant. Considerable heterogeneity within results was revealed. Overall, parent training interventions proved to be effective in improving parental characteristics for parents of children with externalizing behavior problems. Effectiveness was stronger regarding characteristics explicitly targeted by interventions. The findings should encourage health-care providers to apply evidence-based parent training interventions.
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13
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Schorr-Sapir I, Apter A. Evidence for efficacy of parent-based interventions on parental characteristics. Eur Child Adolesc Psychiatry 2019; 28:1023-1024. [PMID: 31332525 DOI: 10.1007/s00787-019-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Alan Apter
- Schneider Children's Medical Center of Israel, Petah-Tikva, Israel. .,Interdisciplinary Center, Herzliya, Israel. .,Ruppin Academic Center, Emek-Hefer, Israel.
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14
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Harrison SE, Li X, Zhang J, Zhao J, Zhao G. A cluster randomized controlled trial to evaluate a resilience-based intervention for caregivers of HIV-affected children in China. AIDS 2019; 33 Suppl 1:S81-S91. [PMID: 31397726 PMCID: PMC7189639 DOI: 10.1097/qad.0000000000002181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Child-Caregiver-Advocacy Resilience (ChildCARE) intervention aims to enhance the psychosocial wellbeing of children affected by parental HIV by providing programing at three levels: child, caregiver, and community. The objective of the current study was to evaluate the intervention's efficacy in improving mental health and parenting outcomes for participating caregivers. DESIGN A cluster randomized controlled trial was used to evaluate initial efficacy of the intervention. METHODS A total of 790 caregivers of children affected by parental HIV were recruited from Henan, China. Caregivers and their children were randomly assigned to one-of-four intervention arms (control, child-only, child + caregiver, child + caregiver + community) to evaluate the multiple components of ChildCARE. Those assigned to receive the caregiver intervention participated in five 2-h intervention sessions designed to improve their parenting skills and enhance their ability to cope with daily stressors. Caregivers reported on their mental health and parenting behaviors at baseline, 12, 24, and 36 months, with mixed effect modeling used to examine intervention effects. RESULTS Caregivers who participated in the intervention reported decreased anxiety and parental stress at 12 months (P < 0.05). Participants also reported increased use of structured parenting skills (i.e., parental demandingness) at 12 and 24 months (P < 0.05). However, by 36 months, they reported significantly lower levels of parental competence (P < 0.01) than those assigned to the control condition. CONCLUSION Preliminary findings suggest that the caregiving component of ChildCARE yields initial improvements in some key parenting and mental health outcomes. However, the challenges of caring for children affected by HIV are complex and may require more intensive intervention to yield marked, positive changes across key caregiver outcomes.
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Affiliation(s)
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior
| | - JiaJia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Junfeng Zhao
- International Research Center for Physical and Psychological Health of Vulnerable Populations, College of Educational Sciences, Henan University, Kaifeng
| | - Guoxiang Zhao
- Department of Psychology, Henan Normal University, Xinxiang, Henan, China
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15
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Ristkari T, Kurki M, Suominen A, Gilbert S, Sinokki A, Kinnunen M, Huttunen J, McGrath P, Sourander A. Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. J Med Internet Res 2019; 21:e11446. [PMID: 30973337 PMCID: PMC6482405 DOI: 10.2196/11446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/09/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022] Open
Abstract
Background Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care. Objective The study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland. Methods The study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions. Results Demographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase (χ12=3.2; P=.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively (t279.5=0.26; P=.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group (t318.8=1.38; P=.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P<.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches. Conclusions The implementation of population-based screening of Web-based parent training intervention with telephone coaching resulted in good feasibility, fidelity, accessibility, and similar satisfaction level post treatment when compared with intervention in RCT research setting. The discontinuation of treatment in the implementation group was exceptionally low.
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Affiliation(s)
- Terja Ristkari
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Sonja Gilbert
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Patrick McGrath
- Centre for Research in Family Health, Izaak Walton Killam Health Centre, Halifax, NS, Canada.,Strongest Families Institute, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
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16
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Bell Scott B, Doss S, Myers D, Hess B. Addressing externalized behavioral concerns in primary care: Listening to the voices of parents. SOCIAL WORK IN HEALTH CARE 2019; 58:14-31. [PMID: 30130473 DOI: 10.1080/00981389.2018.1508114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
This article presents the perceptions parents have of the causative and curative factors for their child's externalized behaviors and what treatment they prefer to receive from their primary care integrated behavioral health team. This is a qualitative study, using interpretative phenomenological analysis. Semi-structured interviews were conducted with a purposive sample of 12 parents representing 14 patients with a disruptive behavior disorder (DBD) who sought care from their primary care physician for treatment of the DBD. Participants spoke of uncertainty of the cause of the DBD and the desire to find parenting approaches that augment the effectiveness of pharmacological intervention provided by the primary care team. Parents' responses suggest that they are eager for more education about their child's DBD and how to engage at-home management of the symptoms. Discussion focused on the import of considering the voices of these parents when implementing brief parent management training programs in integrated behavioral health primary care programs.
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Affiliation(s)
- Becky Bell Scott
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Susanna Doss
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Dennis Myers
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Burrit Hess
- b Waco Family Medicine Residency Program , Waco , Texas
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17
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Gatti U, Grattagliano I, Rocca G. Evidence-based psychosocial treatments of conduct problems in children and adolescents: an overview. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2018; 26:171-193. [PMID: 31984071 PMCID: PMC6762114 DOI: 10.1080/13218719.2018.1485523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 05/27/2018] [Indexed: 06/10/2023]
Abstract
The aims of the present study were to identify empirically supported psychosocial intervention programs for young people with conduct problems and to evaluate the underpinnings, techniques and outcomes of these treatments. We analyzed reviews and meta-analyses published between 1982 and 2016 concerning psychosocial intervention programs for children aged 3 to 12 years with conduct problems. Parent training should be considered the first-line approach to dealing with young children, whereas cognitive-behavioral approaches have a greater effect on older youths. Family interventions have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have yielded moderate effects in both childhood and adolescence. Some limitations were found, especially regarding the evaluation of effects. To date, no single program has emerged as the best. However, it emerges that the choice of intervention should be age-specific and should take into account developmental differences in cognitive, behavioral, affective and communicative abilities.
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Affiliation(s)
- Uberto Gatti
- Department of Health Sciences, Section of Criminology, University of Genoa, Genoa, Italy
| | | | - Gabriele Rocca
- Department of Health Sciences, Section of Criminology, University of Genoa, Genoa, Italy
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18
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Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems. PLoS One 2018; 13:e0202855. [PMID: 30256794 PMCID: PMC6157840 DOI: 10.1371/journal.pone.0202855] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/12/2018] [Indexed: 01/20/2023] Open
Abstract
Objective The aim of this study is to perform the first meta-meta-analysis on the effectiveness of parent-based interventions for children with externalizing behavior problems. Even though parent-based interventions are considered as effective treatments the effects reported in meta-analyses are heterogeneous and the implementation in clinical practice is suboptimal. Recapitulative valid effect predictions are required to close the still existing gap between research findings and clinical practice. The meta-meta-analytic results on changes in child behavior shall result in a clear signal for clinical practice. Methods This meta-meta-analysis encompasses 26 meta-analyses identified via search in electronic databases (PsycINFO, Medline, PubMed). Meta-analyses had to report effects of parent-based interventions on child behavior and focus on children under the age of 13 years with externalizing behavior problems in a clinical setting. Analyses were based on random-effects models. To combine results, the effect estimates of the meta-analyses were transformed to SMD and weighted to correct for primary study overlap. The meta-meta-analysis is registered on PROSPERO, registration number CRD42016036486 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA). Results The results indicate a significant moderate overall effect for child behavior (SMD = 0.46) as well as for parent reports (SMD = 0.51) and observational data (SMD = 0.62). Further analyses focusing on child externalizing behavior yielded significant and moderate effects (SMD = 0.45). All effects remained stable to follow-up. Considerable heterogeneity was observed within results. Conclusion Parent-based interventions are shown to be effective in improving behavior in children with externalizing behavior problems, as assessed using parent reports and observational measures. The present results should encourage health care providers to apply evidence-based parent-based interventions.
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19
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Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Hinkka-Yli-Salomäki S, Kurki M, Lingley-Pottie P. Two-Year Follow-Up of Internet and Telephone Assisted Parent Training for Disruptive Behavior at Age 4. J Am Acad Child Adolesc Psychiatry 2018; 57:658-668.e1. [PMID: 30196869 DOI: 10.1016/j.jaac.2018.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether an internet-based and telephone-assisted parent training intervention, which used whole population screening and which comprehensively targeted symptomatic 4-year-old children, was effective 24 months after the start of treatment. No long-term follow-up studies using a randomized controlled trial (RCT) existed on this subject. METHOD Of the 4,656 children 4 years old who were screened in Southwest Finland, 730 met the criteria for high-level disruptive behavioral problems, and 464 parents agreed to be randomized to the 11-week Strongest Families Smart Website (SFSW) intervention (n = 232) or an educational control (EC) (n = 232). After 24 months, 163 SFSW parents (70%) and 165 EC parents (71%) were still participating. RESULTS When we compared the results at baseline and 24 months, the primary outcome of the Child Behavior Checklist (CBCL) externalizing score showed significantly higher improvements in the SFSW group (effect size 0.22; p < 0.001). This group also showed greater improvements in the secondary outcomes: the CBCL total and internalizing scales, 5 of the 7 CBCL symptom domains, 3 of the 5 DSM subscores, and self-reported parenting skills. Fewer SFSW children (17.5%) than EC children (28.0%) had been referred to child mental health services between baseline and 24 months (odds ratio = 1.8; 95% confidence interval = 1.1-3.1). CONCLUSION The SFSW internet-based and telephone-assisted parental training program was effective 24 months after initiation, underlining the value of identifying children at risk in the community early and providing evidence-based parent training for a large number of families. CLINICAL TRIAL REGISTRATION INFORMATION STRONGEST FAMILIES FINLAND CANADA: Family-based Prevention and Treatment Program of Early Childhood Disruptive Behavior (Fin-Can). http://www.clinicaltrials.gov; NCT01750996.
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Affiliation(s)
- Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland.
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada
| | - Terja Ristkari
- University of Turku, Finland; Turku University Hospital, Finland
| | - Charles Cunningham
- DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada; QEII Health Sciences Centre, Halifax, Nova Scotia
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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21
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Gardner F, Leijten P, Mann J, Landau S, Harris V, Beecham J, Bonin EM, Hutchings J, Scott S. Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundChild disruptive behavioural problems are a large and costly public health problem. The Incredible Years®(IY) parenting programme has been disseminated across the UK to prevent this problem and shown to be effective in several trials. It is vital for policy to know for which families IY is most effective, to be sure that it helps reduce, rather than widen, socioeconomic inequalities. Individual trials lack power and generalisability to examine differential effects; conventional meta-analysis lacks information about within-trial variability in effects.ObjectivesTo overcome these limitations by pooling individual-level data from the IY parenting trials in Europe to examine to what extent it benefits socially disadvantaged families. Secondary objectives examine (1) additional moderators of effects on child behaviour, (2) wider health benefits and potential harms and (3) costs, cost-effectiveness and potential long-term savings.DesignIndividual participant data meta-analysis of 14 randomised trials of the IY parenting intervention.SettingsUK (eight trials), the Netherlands, Ireland, Norway, Sweden and Portugal.ParticipantsData were from 1799 families, with children aged 2–10 years (mean 5.1 years; 63% boys).InterventionsIY Basic parenting programme.Main outcome measuresPrimary outcome was disruptive child behaviour, determined by the Eyberg Child Behavior Inventory Intensity scale (ECBI-I). Secondary outcomes included self-reported parenting practices, parenting stress, mental health, children’s attention deficit hyperactivity disorder (ADHD) and emotional symptoms.ResultsThere were no differential effects of IY on disruptive behaviour in families with different levels of social/socioeconomic disadvantage or differential effects for ethnic minority families, families with different parenting styles, or for children with comorbid ADHD or emotional problems or of different ages. Some moderators were found: intervention effects were strongest in children with more severe baseline disruptive behaviour, in boys, and in children with parents who were more depressed. Wider health benefits included reduced child ADHD symptoms, greater parental use of praise, and reduced harsh and inconsistent discipline. The intervention did not improve parental depression, stress, self-efficacy or children’s emotional problems. Economic data were available for five UK and Ireland trials (maximumn = 608). The average cost per person of the IY intervention was £2414. The probability that the IY intervention is considered cost-effective is 99% at a willingness to pay of £145 per 1-point improvement on the ECBI-I. Estimated longer-term savings over 20 years range from £1000 to £8400 per child, probably offsetting the cost of the intervention.LimitationsLimitations include a focus on one parenting programme; the need to make assumptions in harmonising data; and the fact that data addressed equalities in the effectiveness of, not access to, the intervention.ConclusionsThere is no evidence that the benefits of the IY parenting intervention are reduced in disadvantaged or minority families; benefits are greater in the most distressed families, including parents who are depressed. Thus, the intervention is unlikely to widen socioeconomic inequalities in disruptive behaviour and may have effects in narrowing inequalities due to parent depression. It was as likely to be effective for older as for younger children. It has wider benefits for ADHD and parenting and is likely to be considered to be cost-effective. Researchers/funders should encourage data sharing to test equity and other moderator questions for other interventions; further research is needed on enhancing equality of access to interventions.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Frances Gardner
- Department of Social Policy and Intervention, Centre for Evidence-based Intervention, University of Oxford, Oxford, UK
| | - Patty Leijten
- Department of Social Policy and Intervention, Centre for Evidence-based Intervention, University of Oxford, Oxford, UK
| | - Joanna Mann
- Department of Social Policy and Intervention, Centre for Evidence-based Intervention, University of Oxford, Oxford, UK
| | - Sabine Landau
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Victoria Harris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Stephen Scott
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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de Kwaadsteniet L, Hagmayer Y. Clinicians' Personal Theories of Developmental Disorders Explain Their Judgments of Effectiveness of Interventions. Clin Psychol Sci 2017. [PMID: 29527408 PMCID: PMC5832854 DOI: 10.1177/2167702617712270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based psychotherapy requires clinicians to consider theories of psychopathology and evidence about effectiveness, and their experience when choosing interventions. Research on clinical decision making indicates that clinicians’ theories of disorders might be personal and inform judgments and choices beyond current scientific theory and evidence. We asked 20 child therapists to draw models of how they believed that biological, psychological, environmental, and behavioral factors interact to cause and maintain four common developmental disorders. They were also asked to judge the effectiveness of interventions recommended in the literature. Therapists showed only fair agreement about the factors and a slight to fair agreement about the causal relations between these, and just fair agreement about interventions’ effectiveness. Despite these disagreements, we could predict effectiveness judgments from therapists’ personal theories, which indicates that clinicians use personal theories in decision making. We discuss the implications of these findings for evidence-based practice.
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Shlonsky A, Dennis JA, Devine B, Tufford L, Barlow J, Bjørndal A. Mindfulness-based parenting programmes for improving psychosocial outcomes in children from birth to age 18 and their parents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aron Shlonsky
- The University of Melbourne; Department of Social Work, Melbourne School of Health Sciences; Alan Gilbert Building 161 Barry Street, Carlton Melbourne Victoria Australia 3053
| | - Jane A Dennis
- University of Bristol; Musculoskeletal Research Unit, School of Clinical Sciences; Learning and Research Building [Level 1] Southmead Hospital Bristol UK BS10 5NB
| | - Ben Devine
- Parenting Research Centre; Knowledge Exchange and Implementation Division; Level 5, 232 Victoria Parade East Melbourne Victoria Australia 3002
| | - Lea Tufford
- University of Toronto; Factor-Inwentash Faculty of Social Work; 246 Bloor Street West Toronto ON Canada M5S 1V4
| | - Jane Barlow
- University of Oxford; Department of Social Policy and Intervention; Barnett House 32 Wellington Square Oxford UK OX1 2ER
| | - Arild Bjørndal
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway; RBUP, Postboks 4623 Nydalen Oslo Norway 0405
- University of Oslo; Faculty of Medicine; Oslo Norway
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Erskine HE, Norman RE, Ferrari AJ, Chan GCK, Copeland WE, Whiteford HA, Scott JG. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry 2016; 55:841-50. [PMID: 27663939 DOI: 10.1016/j.jaac.2016.06.016] [Citation(s) in RCA: 292] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/14/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common externalizing disorders. Despite previous research demonstrating that both are longitudinally associated with adverse outcomes, there have been no systematic reviews examining all of the available evidence linking ADHD and CD with a range of health and psychosocial outcomes. METHOD Electronic databases (EMBASE, Medline, and PsycINFO) were searched for studies published from 1980 up to March 2015. Published cohort and case-control studies were included if they reported a longitudinal association between ADHD or CD and adverse outcomes with a minimum follow-up of 2 years. Outcomes with sufficient data were pooled in a random effects meta-analysis to give overall odds ratios (ORs) with corresponding 95% CIs. RESULTS Of the 278 studies assessed, 114 met inclusion criteria and 98 were used in subsequent meta-analyses. ADHD was associated with adverse outcomes including academic achievement (e.g. failure to complete high school; odds ratio [OR] = 3.7, 95% CIs 2.0-7.0), other mental and substance use disorders (e.g. depression; OR = 2.3, 1.5-3.7), criminality (e.g. arrest; OR = 2.4, 1.5-3.8), and employment (e.g., unemployment; OR = 2.0, 1.0-3.9). CD was associated with outcomes relating to academic achievement (e.g. failure to complete high school; OR = 2.7, 1.5-4.7), other mental and substance use disorders (e.g., illicit drug use; OR = 2.1, 1.7-2.6), and criminality (e.g. violence; OR = 3.5, 2.3-5.3). CONCLUSION This study demonstrated that ADHD and CD are associated with disability beyond immediate health loss. Although the analyses could not determine the mechanisms behind these longitudinal associations, they demonstrate the importance of addressing ADHD and CD early in life so as to potentially avert a wide range of future adverse outcomes.
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Affiliation(s)
- Holly E Erskine
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland; and Institute for Health Metrics and Evaluation, University of Washington, Seattle; University of Queensland Centre for Clinical Research, Herston, Queensland.
| | - Rosana E Norman
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland; and Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Gary C K Chan
- Centre for Youth Substance Abuse Research, The University of Queensland
| | | | - Harvey A Whiteford
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland; and Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland; The University of Queensland Centre for Clinical Research, Herston, Queensland; and Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland
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Medlow S, Klineberg E, Jarrett C, Steinbeck K. A systematic review of community-based parenting interventions for adolescents with challenging behaviours. J Adolesc 2016; 52:60-71. [PMID: 27497999 DOI: 10.1016/j.adolescence.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 07/02/2016] [Accepted: 07/17/2016] [Indexed: 01/11/2023]
Abstract
Parenting skills training is an established means of treating challenging behaviours among young children, but there has been limited research on its efficacy when used to treat challenging adolescent behaviour. The aim of this systematic review was to evaluate the efficacy and effectiveness of community-based parenting interventions designed for families with adolescents, as judged in terms of increased knowledge and skills among parents, improvements in adolescent behaviour, and program feasibility within community settings. Results indicated that intervention group parents typically made greater gains than did control group parents on measures of good parenting, with positive flow-on effects to some aspects of challenging adolescent behaviours. Limited evidence suggests that group and individual intervention formats may be equally effective and that there is no advantage to the participation of the target adolescent in the intervention.
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Affiliation(s)
- Sharon Medlow
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW 2006, Australia; Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.
| | - Emily Klineberg
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW 2006, Australia; Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia; NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia.
| | - Carmen Jarrett
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia.
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW 2006, Australia; Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.
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Wittkowski A, Dowling H, Smith DM. Does Engaging in a Group-Based Intervention Increase Parental Self-efficacy in Parents of Preschool Children? A Systematic Review of the Current Literature. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:3173-3191. [PMID: 27795657 PMCID: PMC5061830 DOI: 10.1007/s10826-016-0464-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
As the preschool years are a formative period for long-term physical and mental health, this period is recognised as an important window for early effective intervention. Parenting behaviour is a key factor to target in order to optimise child development. Group-based interventions for parents are considered efficient and cost effective methods of early intervention and have been found to improve child behaviour and adjustment. Self-efficacy is key to behaviour change and as such parental self-efficacy should be a consideration in interventions aimed at influencing parenting behaviour. Therefore, the purpose of this systematic review was to examine the impact of group-based early interventions for parents of preschool children on parental self-efficacy. Nine databases were searched (ASSIA, CINAHL, EMBASE, Maternity and Infant Care, Ovid Medline, PsycINFO, Pubmed, Science Direct and Web of Science). Studies were included if they were a randomised controlled trial of a group-based intervention for parents of preschool children and measured change in parental self-efficacy. Fifteen studies were identified. Although changes in parental self-efficacy following a group-based intervention were noted in the majority of studies reviewed, the methodological quality of the studies included in the review means these findings have to be interpreted with caution; only seven studies were rated to be methodologically adequate. Further research is needed to understand the mechanisms by which these interventions may improve parental self-efficacy. Studies specifically examining the impact of such interventions on paternal self-efficacy are also warranted.
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Affiliation(s)
- Anja Wittkowski
- School of Psychological Sciences, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK
| | - Hannah Dowling
- School of Psychological Sciences, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK
| | - Debbie M. Smith
- School of Psychological Sciences, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL UK
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Wynne C, Doyle C, Kenny R, Brosnan E, Sharry J. A first-level evaluation of a family intervention for adolescent social, emotional and behavioural difficulties in Child and Adolescent Mental Health Services. J Child Adolesc Ment Health 2016; 28:33-46. [DOI: 10.2989/17280583.2015.1135804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zemp M, Bodenmann G, Mark Cummings E. The Significance of Interparental Conflict for Children. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. This review summarizes research and theory on the impact of interparental conflict for child well-being. Drawing from this literature the primary focus of many family programs on parenting seems unconvincing. Contemporary approaches increasingly acknowledge the importance of addressing the interparental relationship to reduce and/or prevent behavior problems in children. However, studies examining the impact of enhancing the parents’ relationship for children are still in their infancy. Yet, this emerging line of research indicates that couple-focused interventions alone or adjunct to parenting programs may be a potent means of increasing child adjustment. The potential of couple-focused interventions to support children’s adjustment and practical implications of such approaches are discussed. Future directions are suggested that urgently need to be addressed to advance this promising area of family psychology.
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Affiliation(s)
- Martina Zemp
- Department of Psychology, University of Zurich, Switzerland
| | - Guy Bodenmann
- Department of Psychology, University of Zurich, Switzerland
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Ulfsdotter M, Lindberg L, Månsdotter A. A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus. PLoS One 2015; 10:e0145201. [PMID: 26681349 PMCID: PMC4683000 DOI: 10.1371/journal.pone.0145201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs) as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC). The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness. METHODS A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data. RESULTS The cost was € 326.3 per parent, of which € 53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and € 272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of € 47 290 per gained QALY. The sensitivity analyses resulted in ratios from € 41 739 to € 55 072. With the common Swedish threshold value of € 55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent. CONCLUSION Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.
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Affiliation(s)
- Malin Ulfsdotter
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Lene Lindberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Månsdotter
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Hanratty J, Macdonald G, Livingstone N. Child-focused psychosocial interventions for anger and aggression in children under 12 years of age. Hippokratia 2015. [DOI: 10.1002/14651858.cd011788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jennifer Hanratty
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Geraldine Macdonald
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
| | - Nuala Livingstone
- Queen's University Belfast; School of Sociology, Social Policy and Social Work; 6 College Park Belfast UK BT7 1LP
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Abstract
SummaryMost individuals who have lived in foster homes, residential care or adoptive families for substantial periods (‘people affected by public care or adoption’) show normal psychological adjustment as adults, although rates of mental disorders, hospital admission and suicide are increased. Research focusing on the experiences of this group of people can help professionals better understand their behaviour and attitude towards help. Psychiatric symptoms can be multifaceted, including complex trauma presentations. The specific mental health needs of this population are increasingly being recognised in child and adolescent mental health services but less so in adult services. In this article we describe life experiences of people affected by public care or adoption, examine the lifelong impact of these experiences on mental health and functioning, and offer practical suggestions for clinical work with them.
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Sampaio F, Sarkadi A, Salari R, Zethraeus N, Feldman I. Cost and effects of a universal parenting programme delivered to parents of preschoolers. Eur J Public Health 2015; 25:1035-42. [PMID: 26063699 DOI: 10.1093/eurpub/ckv106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parenting programmes are effective in improving child behaviour and parental well-being, but long follow-up studies of universally offered programmes are scarce. METHODS A cluster randomized controlled trial was conducted to assess the costs and effects of Triple P levels 2-3 on child externalizing behaviours and parental mental health. The programme was offered universally to parents of preschoolers (self-selection allowed). Preschools were randomized to Triple P or a waitlist control. Health outcomes were reduction in externalizing behaviours measured on the Eyberg Child Behaviour Inventory-22 and improvement in parental mental health measured on the Depression Anxiety Stress Scales collected at baseline, 6-, 12- and 18-month follow-up. Child outcomes were based on 355 children aged 3-5 years (child sample) and parental outcomes on 759 parents (parental sample) with baseline data. Costs were collected from a municipality perspective, including 312 children and 488 parents with baseline data in the intervention preschools. RESULTS Sixty-seven (29%) parents attended the intervention. Triple P showed no significant improvement in child externalizing behaviours or parental mental health at either of the follow-up points. Triple P had an average yearly total cost of 3007 Swedish Krona (SEK) (€323) per child or 1922 SEK (€207) per parent. Running Triple P cost 227 SEK (€24) per child or 145 SEK (€16) per parent yearly. CONCLUSION Offering low intensity levels of Triple P with 29% attendance may not be a reasonable use of public resources, as no evidence of improvement in child externalizing behaviours or parental mental health was found.
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Affiliation(s)
- Filipa Sampaio
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Sarkadi
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Raziye Salari
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden 2 Department of Clinical Neuroscience and Stockholm Brain Institute, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- 3 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Inna Feldman
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Herr L, Mingebach T, Becker K, Christiansen H, Kamp-Becker I. Wirksamkeit elternzentrierter Interventionen bei Kindern im Alter von zwei bis zwölf Jahren. KINDHEIT UND ENTWICKLUNG 2015. [DOI: 10.1026/0942-5403/a000154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Mittels eines systematischen Reviews von 68 Meta-Analysen und Übersichtsartikeln wird überprüft, welche elternzentrierten Interventionen für Kinder im Alter von zwei bis zwölf Jahren wirksam sind und welche psychischen Störungen effektiv behandelt werden können. Insgesamt zeigte sich, dass ein enger Einbezug der Eltern in die Behandlung der Kinder mit internalisierenden Störungen (v. a. bei jüngeren Kindern) sinnvoll ist. Hierbei scheinen vor allem kognitiv-behaviorale Ansätze mit Elterneinbezug wirksam zu sein. Hinsichtlich externalisierender Verhaltensprobleme erreichen behaviorale Elterntrainings neben einer Reduktion der Verhaltensprobleme auch positive Effekte auf Erziehungsverhalten und das elterliche psychische Wohlbefinden. Besonders behaviorale elternzentrierte Interventionen, deren Wirksamkeit nachgewiesen ist, sollten künftig häufiger angewendet werden und eine Möglichkeit zur Abrechnung über die Krankenkassen geschaffen werden.
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Affiliation(s)
- Linda Herr
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Tanja Mingebach
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Katja Becker
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Hanna Christiansen
- AG Klinische Kinder- und Jugendpsychologie, Fachbereich Psychologie, Philipps-Universität Marburg
| | - Inge Kamp-Becker
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
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Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. Dev Psychopathol 2014; 25:1045-63. [PMID: 24229548 DOI: 10.1017/s0954579413000369] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
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Sampaio F, Feldman I. Are group-based parenting programmes in Sweden a cost-effective way of reducing early child behaviour problems? BMC Health Serv Res 2014. [PMCID: PMC4123142 DOI: 10.1186/1472-6963-14-s2-p107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2014; 2014:CD002020. [PMID: 24838729 PMCID: PMC10898322 DOI: 10.1002/14651858.cd002020.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parental psychosocial health can have a significant effect on the parent-child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group-based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2011: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group-based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting-list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. MAIN RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive-behavioural and multimodal. Overall, we found that group-based parenting programmes led to statistically significant short-term improvements in depression (standardised mean difference (SMD) -0.17, 95% confidence interval (CI) -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be statistically significant at six month follow-up, and none were significant at one year. There was no evidence of any effect on self-esteem (SMD -0.01, 95% CI -0.45 to 0.42). None of the trials reported on aggression or adverse effects.The limited data that explicitly focused on outcomes for fathers showed a statistically significant short-term improvement in paternal stress (SMD -0.43, 95% CI -0.79 to -0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short-term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
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Affiliation(s)
- Jane Barlow
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry, UK, CV4 7LF
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Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clin Child Fam Psychol Rev 2014; 16:18-34. [PMID: 23420407 DOI: 10.1007/s10567-013-0128-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evidence-based interventions are often unavailable in everyday clinical settings. This may partly reflect practitioners' assumptions that research evidence does not reflect "real-world" conditions. To examine this further, we systematically assessed the clinical effectiveness of parent management training (PMT) for the treatment of child disruptive behavior across different real-world practice contexts. We identified 28 relevant randomized controlled trials from a systematic search of electronic bibliographic databases and conducted a meta-analysis of child outcomes across trials. Planned subgroup analyses involved comparisons between studies grouped according to individual real-world practice criteria and total real-world practice criteria scores, reflecting the extent to which PMT was delivered by non-specialist therapists, to a clinic-referred population, in a routine setting, and as part of a routine service. Meta-analysis revealed a significant overall advantage for PMT compared with waitlist control conditions. Subgroup analyses did not demonstrate significant differences in effect size estimates according to the total number of real-world practice criteria met by studies. Moreover, no consistent relationships were found between specific practice criteria and effect size estimates. In conclusion, PMT appears to be an effective treatment for children with disruptive behavior problems. There was no clear evidence that conducting PMT in real-world practice contexts is a deterrent to achieving effective child behavior outcomes, although relative advantage to "usual care" was not directly examined and the power of the analysis was limited as a result of significant heterogeneity. More research is needed to investigate whether this finding is generalizable to other psychological interventions. Suggestions are also made for developing more differentiated criteria to assist with evaluating the specific applicability of research evidence to different care providers.
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Charles JM, Edwards RT, Bywater T, Hutchings J. Micro-costing in public health economics: steps towards a standardized framework, using the incredible years toddler parenting program as a worked example. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 14:377-89. [PMID: 23306596 DOI: 10.1007/s11121-012-0302-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multi-agency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children's conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multi-agency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial set-up costs were £3305.73; recurrent delivery costs for the program based on eight parents attending a group were £752.63 per child, falling to £633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were £1509.28 per child based on eight parents, falling to £1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively.
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Affiliation(s)
- J M Charles
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Dean Street Building, Bangor, Gwynedd, LL57 1UT, UK.
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Segrott J, Gillespie D, Holliday J, Humphreys I, Murphy S, Phillips C, Reed H, Rothwell H, Foxcroft D, Hood K, Roberts Z, Scourfield J, Thomas C, Moore L. Preventing substance misuse: study protocol for a randomised controlled trial of the Strengthening Families Programme 10-14 UK (SFP 10-14 UK). BMC Public Health 2014; 14:49. [PMID: 24438460 PMCID: PMC3902023 DOI: 10.1186/1471-2458-14-49] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/18/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevention of alcohol, drug and tobacco misuse by young people is a key public health priority. There is a need to develop the evidence base through rigorous evaluations of innovative approaches to substance misuse prevention. The Strengthening Families Programme 10-14 is a universal family-based alcohol, drugs and tobacco prevention programme, which has achieved promising results in US trials, and which now requires cross-cultural assessment. This paper therefore describes the protocol for a randomised controlled trial of the UK version of the Strengthening Families Programme 10-14 (SFP 10-14 UK). METHODS/DESIGN The trial comprises a pragmatic cluster randomised controlled effectiveness trial with families as the unit of randomisation, with embedded process and economic evaluations. Participating families will be randomised to one of two treatment groups - usual care with full access to existing services (control group), or usual care plus SFP 10-14 UK (intervention group). The trial has two primary outcomes - the number of occasions that young people report having drunk alcohol in the last 30 days, and drunkenness during the last 30 days, both dichotomised as 'never' and '1-2 times or more'. The main follow-up is at 2 years past baseline, and short-term and intermediate outcomes are also measured at 9 and 15 months. DISCUSSION The results from this trial will provide evidence on the effectiveness and cost-effectiveness of an innovative universal family-based substance misuse prevention programme in a UK context. TRIAL REGISTRATION Current Controlled Trials ISRCTN63550893.
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Affiliation(s)
- Jeremy Segrott
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - David Gillespie
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Jo Holliday
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - Ioan Humphreys
- Swansea Centre for Health Economics; College of Health and Human Sciences, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics; College of Health and Human Sciences, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Hayley Reed
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - Heather Rothwell
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - David Foxcroft
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straw’s Lane, OX3 0FL Oxford, UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Zoe Roberts
- Institute of Primary Care and Public Health, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Jonathan Scourfield
- Cardiff School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, CF10 3WT Cardiff, UK
| | - Claire Thomas
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD Cardiff, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, G12 8RZ Glasgow, UK
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The prevention program for externalizing problem behavior (PEP) improves child behavior by reducing negative parenting: analysis of mediating processes in a randomized controlled trial. J Child Psychol Psychiatry 2013. [DOI: 10.1111/jcpp.12177] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013; 13:985. [PMID: 24139323 PMCID: PMC4015286 DOI: 10.1186/1471-2458-13-985] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION ClinicalTrials.gov # NCT01750996.
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Affiliation(s)
- Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
- Center for Child and Adolescent Mental Health, North Norway (RBUP), University of Tromsø, 9037, Breivika, Norway
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
- Strongest Families Institute, 7105 Chebucto Road, Suite 355, Halifax, Nova Scotia B3L 4W8, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katharine Filbert
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Itäinen Pitkäkatu 30, 20700, Turku, Finland
- Department of Public Health, University on Turku, FI-20014, Turun Yliopisto, Finland
| | - Penny Corkum
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katja Lampi
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anne Penttinen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anita Unruh
- Dalhousie University, Faculty of Health Professions, Burbidge Building, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jenni Vuorio
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Carolyn Watters
- Dalhousie University, Faculty of Computer Science, 6050 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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Simkiss DE, Snooks HA, Stallard N, Kimani PK, Sewell B, Fitzsimmons D, Anthony R, Winstanley S, Wilson L, Phillips CJ, Stewart-Brown S. Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial. BMJ Open 2013; 3:bmjopen-2013-002851. [PMID: 23906953 PMCID: PMC3733301 DOI: 10.1136/bmjopen-2013-002851] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. DESIGN Multicentre randomised controlled trial with cost-effectiveness analysis. SETTING Early years centres in four deprived areas of South Wales. PARTICIPANTS Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. INTERVENTION The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. MAIN OUTCOME MEASURES Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. RESULTS There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With '+' indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI -1.90 to 3.69); in supportive parenting, +0.17 (95%CI -0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485-46 578) over 5 years and £18 954 (range 11 664-25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. CONCLUSIONS Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. TRIAL REGISTRATION The trial is registered with Current Controlled Trials ISRCTN13919732.
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Affiliation(s)
- D E Simkiss
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - H A Snooks
- Centre for Health Information, Research and Evaluation, Institute of Life Science, College of Medicine, Swansea University, Swansea, Wales, UK
| | - N Stallard
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - P K Kimani
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - B Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, SA2 8PP, Swansea University, Swansea, Wales, UK
| | - D Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, SA2 8PP, Swansea University, Swansea, Wales, UK
| | - R Anthony
- Centre for Health Information, Research and Evaluation, Institute of Life Science, College of Medicine, Swansea University, Swansea, Wales, UK
| | - S Winstanley
- Centre for Health Information, Research and Evaluation, Institute of Life Science, College of Medicine, Swansea University, Swansea, Wales, UK
| | - L Wilson
- Centre for Health Information, Research and Evaluation, Institute of Life Science, College of Medicine, Swansea University, Swansea, Wales, UK
| | - C J Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, SA2 8PP, Swansea University, Swansea, Wales, UK
| | - S Stewart-Brown
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
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Tellegen CL, Sanders MR. Stepping Stones Triple P-Positive Parenting Program for children with disability: a systematic review and meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1556-71. [PMID: 23475006 DOI: 10.1016/j.ridd.2013.01.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 05/12/2023]
Abstract
This systematic review and meta-analysis evaluated the treatment effects of a behavioral family intervention, Stepping Stones Triple P (SSTP) for parents of children with disabilities. SSTP is a system of five intervention levels of increasing intensity and narrowing population reach. Twelve studies, including a total of 659 families, met eligibility criteria. Studies needed to have evaluated SSTP, be written in English or German, contribute original data, and have sufficient data for analyses. No restrictions were placed on study design. A series of meta-analyses were performed for seven different outcome categories. Analyses were conducted on the combination of all four levels of SSTP for which evidence exists (Levels 2-5), and were also conducted separately for each level of SSTP. Significant moderate effect sizes were found for all levels of SSTP for reducing child problems, the primary outcome of interest. On secondary outcomes, significant overall effect sizes were found for parenting styles, parenting satisfaction and efficacy, parental adjustment, parental relationship, and observed child behaviors. No significant treatment effects were found for observed parenting behaviors. Moderator analyses showed no significant differences in effect sizes across the levels of SSTP intervention, with the exception of child observations. Risk of bias within and across studies was assessed. Analyses suggested that publication bias and selective reporting bias were not likely to have heavily influenced the findings. The overall evidence base supported the effectiveness of SSTP as an intervention for improving child and parent outcomes in families of children with disabilities. Limitations and future research directions are discussed.
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Affiliation(s)
- Cassandra L Tellegen
- Parenting and Family Support Centre, The University of Queensland, St Lucia, Australia.
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O'Neill D, McGilloway S, Donnelly M, Bywater T, Kelly P. A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:85-94. [PMID: 21853340 DOI: 10.1007/s10198-011-0342-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 07/20/2011] [Indexed: 05/31/2023]
Abstract
Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.
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Affiliation(s)
- Donal O'Neill
- Department of Economics, NUI Maynooth, Ireland and Research Fellow IZA, Bonn, Germany.
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Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2012:CD002020. [PMID: 22696327 DOI: 10.1002/14651858.cd002020.pub3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Parental psychosocial health can have a significant effect on the parent-child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group-based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2012: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group-based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting-list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. MAIN RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive-behavioural and multimodal. Overall, we found that group-based parenting programmes led to statistically significant short-term improvements in depression (standardised mean difference (SMD) -0.17, 95% confidence interval (CI) -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be statistically significant at six month follow-up, and none were significant at one year. There was no evidence of any effect on self-esteem (SMD -0.01, 95% CI -0.45 to 0.42). None of the trials reported on aggression or adverse effects.The limited data that explicitly focused on outcomes for fathers showed a statistically significant short-term improvement in paternal stress (SMD -0.43, 95% CI -0.79 to -0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short-term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
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Affiliation(s)
- Jane Barlow
- Health Sciences Research Unit, Warwick Medical School, Coventry, UK.
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Coombes L, Allen DM, Foxcroft D. An exploratory pilot study of the Strengthening Families Programme 10–14 (UK). DRUGS: EDUCATION, PREVENTION AND POLICY 2012. [DOI: 10.3109/09687637.2012.658889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Kilian R, Losert C, Park AL, McDaid D, Knapp M. Cost-Effectiveness Analysis in Child and Adolescent Mental Health Problems: An Updated Review of Literature. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2010.9721825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Effective intervention programming: improving maternal adjustment through parent education. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 40:211-23. [PMID: 22246615 DOI: 10.1007/s10488-011-0397-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study assessed the secondary effects of a parent training intervention program on maternal adjustment, with a focus on understanding ways in which program efficacy differed for participants as a function of whether or not their children had behavior problems. Mothers (N = 99) of toddlers (2-3 years of age) were randomly assigned to receive one of three levels of intervention: (1) informational booklet (2) booklet + face-to-face parent training sessions, or (3) booklet + web-based parent training sessions. Findings indicated that all levels of intervention were associated with increases in maternal well-being for participants with typically developing children. Mothers of toddlers with behavior problems, however, did not benefit from receiving only the booklet but significantly benefitted from receiving either the face-to-face or web-based interventions. Findings are discussed in terms of efficient and efficacious program dissemination and the resulting implications for public policy.
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Leijten P, Overbeek G, Janssens JMAM. Effectiveness of a parent training program in (pre)adolescence: evidence from a randomized controlled trial. J Adolesc 2011; 35:833-42. [PMID: 22177195 DOI: 10.1016/j.adolescence.2011.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/17/2011] [Accepted: 11/27/2011] [Indexed: 10/14/2022]
Abstract
The present randomized controlled trial examined the effectiveness of the parent training program Parents and Children Talking Together (PCTT) for parents with children in the preadolescent period who experience parenting difficulties. The program is focused on reducing child problem behavior by improving parents' communication and problem solving skills, and disciplining behavior. Largest effects were expected for families with higher SES, and with children in mid-adolescence. Multi-informant and multi-method data were used from 78 self-referred families with children aged 9-16 (M=13.09, SD=1.75). Intention-to-treat analysis (retention rate 95%; immediate posttest only) showed that participation in PCTT significantly improved parents' communication and problem solving skills (F(1,70)=11.77, p<0.01 and F(1,70)=12.87, p<0.01), and reduced their dysfunctional disciplining behavior in conflict situations (F(1,70)=5.25, p<.0.05). The PCTT intervention was most effective for parents with higher SES and for parents with children between the ages of 14 and 16. No consistent gender effects were found.
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Affiliation(s)
- Patty Leijten
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
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50
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Bonin EM, Stevens M, Beecham J, Byford S, Parsonage M. Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study. BMC Public Health 2011; 11:803. [PMID: 21999434 PMCID: PMC3209459 DOI: 10.1186/1471-2458-11-803] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 10/14/2011] [Indexed: 12/02/2022] Open
Abstract
Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder. Methods A decision-analytic Markov model compares two scenarios: 1) a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2) the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted. Results Results strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices). Conclusions Effective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.
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Affiliation(s)
- Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
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