A review of Australian Government funding of parenting intervention research

Specialist early parenting intervention: Effectiveness of a novel nurse-led approach for rural families

BACKGROUND

Rural Australian families report lower access to specialist early parenting services than urban families. To address the early parenting needs of rural families with children aged 0-3, a novel specialist-nursing early parenting service, Tresillian To You, was implemented for five rural communities in New South Wales, Australia. This study aimed to investigate the initial impact and reach of the service.

METHODS

Convenience sampling was used to recruit 36 parents who attended the service. Of these, 34 completed structured pre-and-post intervention phone interviews. Additional data were collected from the parent and child health record. Data were imported into SPSS for descriptive and inferential data analysis.

FINDINGS

All parent participants were mothers, with a mean age of 31.5 (SD 4.582). Sleep and settling was the primary reason for referral (78%, n = 28). Following service engagement, statistically significant improvements were seen in parent adjustment (95% CI = -1.71, -0.52, p < .001), parent comprehensibility (95% CI = -1.81, -0.42, p = .003), and parent perception of child sleep (95% CI = 16.3, 34.9, p < .001). Families from non-target communities (n = 15) reported a higher level of need at baseline, compared with families from target rural communities (n = 21). Following service engagement, a similar level of benefit was reported between both groups.

DISCUSSION

Preliminary evidence suggests that this new service may be an effective method of providing specialist early parenting intervention for families in rural communities.

PRACTICE IMPLICATIONS

The provision of effective nurse-led specialist early child and family interventions may help to alleviate early parenting difficulty for rural families, leading to improvements in child and family outcomes.

A self-paced online emotion socialization intervention for parents of children with challenging behavior: Tuning in to Kids OnLine

Background

Evidence-based parenting programs delivered using online technology are an important way to enhance program uptake. To date, programs that address emotion socialization processes, such as Tuning in to Kids, have always been delivered in person, via group or one-to-one delivery. This study used a randomized control design to examine the efficacy of the self-paced Tuning in to Kids OnLine (TIKOL).

Method

Participants were 150 parents of children aged 4-10 years old with challenging behaviors, randomized into intervention or 10-month waitlist control. Parents and teachers completed questionnaires at baseline and 6 months after the intervention (equivalent time points for controls) measuring parent wellbeing, parent emotion socialization, parent efficacy, child behavior, and anxiety.

Results

Analyses, using mixed methods multilevel modeling, showed that intervention parents reported significantly reduced emotion dismissiveness and increased emotion coaching, empathy and efficacy compared to controls who did not. Parents participating in TIKOL also reported that their children's behavior problems and anxiety were significantly improved. Greater engagement (modules watched and duration of support calls) was associated with more significant improvements.

Conclusion

Findings provide preliminary support for the efficacy of TIKOL in improving parents' emotion socialization and reducing child behavior problems and anxiety, especially when efforts to support online engagement are utilized. Further evaluation using independent observations and a sample representing a wider demographic would strengthen these findings.

Clinical trial registration

Australian and New Zealand Clinical Trials Registry No. ACTRN12618000310268.

Ten recommendations for reducing the long-term costs of conduct problems: A commentary on the economic analysis of Goulter et al. (2023)

The economic analysis of Goulter et al. (2023) identifies the long-term financial costs arising from conduct problems in the kindergarten period, including those associated with later criminal activity, lost offender productivity, victim costs and government and medical services. These costs are substantial and provide policymakers with a compelling argument for investing in early intervention and prevention of conduct problems. The ultimate goal of reducing the long-term costs of early conduct problems is likely to be achieved only through the coordinated efforts of many stakeholders and diverse courses of action. Outlined here are 10 recommendations for investment that in my view would support progress towards this outcome.

The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions

Triple P is an integrated, multi-level system of evidence-based parenting support designed to promote the well-being of children and families to reduce prevalence rates of social, emotional, and behavioral problems in children and adolescents and to prevent child maltreatment. The system developed gradually over four decades to address the complex needs of parents and children from diverse family, socioeconomic and cultural backgrounds. It blends universal and targeted programs, a focus on developing parental self-regulation capabilities, and adopts a life span perspective with a population health framework. The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention. Seven stages of program development are outlined from initial theory building and development of the core parenting program through to the sustained deployment of the intervention system delivered at scale. The importance of ongoing research and evaluation is highlighted so that different programs within the system evolve and adapt to address the contemporary concerns and priorities of families in diverse cultural contexts. A well-trained workforce is essential to deliver evidence-based programs, in a need-responsive manner that blends both fidelity of delivery and flexibility and is tailored to respond to the needs of individual families and local context. Programs need to be gender-sensitive, culturally informed, and attuned to the local context including relevant policies, resources, cultural factors, funding, workforce availability and their capacity to implement programs.

Oppositional defiant disorder

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

Mechanisms of Change in Population-Based Parenting Interventions for Children and Adolescents

OBJECTIVE

Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes.

METHOD

Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention.

RESULTS

A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved.

CONCLUSIONS

Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.