Supporting Families Affected by Adversity: An Open Feasibility Trial of Family Life Skills Triple P

This pilot feasibility study examined the effects of a new trauma-informed parenting program, Family Life Skills Triple P (FLSTP), in an open uncontrolled trial conducted in a regular service delivery context via video conferencing. FLSTP was trialed as a group-delivered 10-session intervention. Program modules target positive parenting skills (4 sessions) and adult life skills including coping with emotions, taking care of relationships, self-care, dealing with the past, healthy living, and planning for the future. Participants were 50 parents with multiple vulnerabilities, due to social disadvantage or adverse childhood experiences, who had children aged 3-9 with early onset behavior problems. Outcomes were assessed across four data collection points: baseline, mid-intervention (after Session 4), post-intervention, and 3-month follow up. Findings show moderate to large intra-group effect sizes for changes in child behavior problems, parenting practices and risk of child maltreatment, and medium effect sizes for parental distress, emotion regulation and self-compassion. Parents and practitioners reported high levels of consumer satisfaction with the program. Parents with lower levels of parental self-efficacy, lower personal agency and higher baseline scores on a measure of child abuse potential were at greater risk of not completing the program. The strength of these preliminary findings indicates that a more rigorous evaluation using a randomized clinical trial is warranted.

Exploring Indigenous Community Conceptions of Parent Wellbeing: A Qualitative Analysis

Using non-Indigenous perspectives of parental social and emotional wellbeing in the design and application of parent support programs can undermine program effectiveness as it may not account for Indigenous family structures and community values. With a clearer understanding of Indigenous parent wellbeing and its determinants, parenting interventions can be more appropriately designed and tailored to provide support for Indigenous families. This study utilised a community-based participatory action research approach involving collaboration between the research team, participants, and community advisory groups to explore Indigenous parents' and carers' conceptions of wellbeing. Participants' cultural perspectives on parent wellbeing were collected through semi-structured focus groups and in-depth interviews (N = 20). Thematic analysis was undertaken using theory-driven and interpretative phenomenological analysis. Eleven themes emerged as risk and protective factors across three domains: child domain (i.e., school attendance and education, respect, routine, development), parent domain (i.e., role modelling, self-regulation of body, self-regulation of mind and emotions, parenting strategies), and context domain (i.e., connections to family and kinship, community, access to services). It is noteworthy that parents reported three super-ordinate intersecting themes across all domains: connection to culture, Country, and spirituality. In addition, Indigenous parents' and carers' conception of their own wellbeing is closely linked to their children's wellbeing, their lived community context, and expected personal indicators. In recognising and working with this holistic view of Indigenous parent wellbeing, parent support programs can be optimally designed and implemented in Indigenous communities.

Pakistani orphanage caregivers' perspectives regarding their caregiving abilities, personal and orphan children's psychological wellbeing

BACKGROUND

Pakistan is home to 4.6 million children who have been orphaned. Limited data on caregiving in orphanages suggests that caregivers do not have specialized training and experience heavy workloads and high-stress levels. Supporting these caregivers to provide responsive and consistent caregiving can improve their well-being along with the psychological and physical development of children who have been orphaned. This research explored the main caregiving-related challenges faced by caregivers in orphanage settings, their professional and personal needs and perceived emotional and behavioural problems manifesting in children under their care.

METHOD

This research adopted a qualitative research design with a thematic analysis approach. Semi-structured interviews were conducted with 14 caregivers who were currently caring for four to 12-year-old children in Pakistani orphanages.

RESULTS

Five main themes: (1) religiosity, (2) economic relief, (3) caregivers' needs and well-being, (4) caring for children who have been orphaned and (5) need for context specific training, emerged from the data, which included several subthemes. Findings revealed the presence of positive religious views regarding the upbringing and care of children who have been orphaned. Work-provided accommodation was an important economic relief. Caregivers' psychological, physiological and personal lives were affected by job-related stress and demands. Many helpful and unhelpful parenting practices were documented, and challenges such as children's verbal and physical aggression, stealing, non-cooperation and poor social skills were reported. The main professional issues included low salary, high numbers of children in care and lack of context specific professional caregiving training provided.

CONCLUSION

This study established the need for a tailored programme that suits the context specific caregiving needs in Pakistani orphanages to support the training and professional growth of caregivers and promote their wellbeing along with positive developmental outcomes in the children under their care.

A review of Australian Government funding of parenting intervention research

OBJECTIVES

Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research.

METHOD

We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011-2020.

RESULTS

Parenting intervention research received 0.25% of the NHMRC and ARC research budgets.

CONCLUSIONS

There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short- and long-term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding.

IMPLICATIONS FOR PUBLIC HEALTH

Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families.

Scaling Up Parenting Interventions is Critical for Attaining the Sustainable Development Goals

Of all the potentially modifiable influences affecting children's development and mental health across the life course, none is more important than the quality of parenting and family life. In this position paper, we argue that parenting is fundamentally linked to the development of life skills that children need in order to achieve the United Nations Sustainable Development Goals. We discuss key principles that should inform the development of a global research and implementation agenda related to scaling up evidence-based parenting support programs. Research over the past 50 years has shown that parenting support programs of varied intensity and delivery modality can improve a wide range of developmental, emotional, behavioral and health outcomes for parents and their children. Such findings have been replicated across culturally and socioeconomically diverse samples, albeit primarily in studies from Western countries. We highlight the evidence for the relevance of parenting interventions for attaining the SDGs globally, and identify the barriers to and strategies for achieving their scale-up. The implications of the global COVID-19 pandemic for the delivery of evidence-based parenting support are also discussed.

Predicting positive outcomes and successful completion in an online parenting program for parents of children with disruptive behavior: An integrated data analysis

Online delivery of parenting support is steadily increasing, yet the factors that influence program engagement and efficacy are still understudied. This study used an integrated data analysis approach to identify family and program-related factors that influence outcomes. We combined individual data from seven published efficacy trials of the web-based version of the Triple P-Positive Parenting Program. Data were analyzed for 985 families with children aged between 2 and 12 years (M = 4.87; SD = 2.14) using a Latent Change Score approach. At post-intervention, sociodemographic factors were not predictive of changes in child behavior problems, while parents of boys and those with higher education showed greater improvements in dysfunctional parenting. Parents who were initially more confident in their parenting showed more overall gains while parents with more initial adjustment difficulties showed less improvement. Only the effect of baseline child behavior problems on changes in dysfunctional parenting was moderated by treatment condition. At follow-up, program variant and completion were the primary outcome predictors, with completion found to be related to initial parenting confidence, internet usage and program variant. The implications of these findings for reaching and retaining parents in online programs across all phases of the engagement process are discussed.

Comparing apples and pears: misleading conclusions about the population mental health impact of a parenting programme, a commentary on Marryat, Thompson and Wilson (2017)

Background

The article by Marryat, Thompson and Wilson (2017) in BMC Pediatrics presents an evaluation of the implementation of the Triple P system as a public health intervention conducted by the Glasgow City Council and NHS Greater Glasgow and Clyde.

Discussion

Unfortunately, the conclusions drawn are questionable for multiple reasons. The lack of a controlled design precludes defensible conclusions about intervention effects free from routine threats to internal validity. There was a substantial mismatch between the intervention sample and the population sample assessed. The article’s title and abstract leave readers with the mistaken impression that the children assessed for outcome were suitably representative of intervention families, when in fact many of the children in the intervention families were missing from the teacher-report outcome assessment (a single questionnaire), and many or most of the children in the teacher-report outcome assessment belonged to families who had never received the intervention. Although Triple P targets parent-child relations and child behavioural and emotional problems at home, Marryat et al. narrowly defined mental health impact as child difficulties in nursery or preschool, while not reporting data from practitioners and parents in the same evaluation that did not support the authors’ conclusion. The paper was further diminished by a number of misleading statements and factual errors related for example to other research on Triple P.

Summary

Studying the extent to which child mental health functioning at home can generalise to school settings is an important topic of inquiry in relation to parenting support interventions, but unfortunately the Marryat et al. article did not move this area forward.

Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities

This paper evaluates program, workplace and process factors associated with implementation and sustainment of an evidence-based parenting support program (EBP) in disadvantaged communities. Correlation analyses and binary logistic regressions were used to assess the associations between key implementation support factors and program implementation (at 18 months) and sustainment (at 36 months) post training with (N=35) Australian Aboriginal and Torres Strait Islander family support providers using the Triple P - Positive Parenting Program in Indigenous child protection agencies. This study demonstrated that for implementation at 18 months, there was a trend for implementing providers to report higher levels of partnership support, perceived program benefit, workplace support and workplace cohesion. However, the only significant relationship was with partnership support (r=.31 p<0.05), and regression analysis indicated that none of the variables were significant predictors of program implementation. For sustained implementation at 36 months, no relationship was found between sustainment and program characteristics, workplace characteristics, supervision and peer support or sustainability planning. Supportive coaching was the only significant correlate (r=0.46, p<0.01) and predictor [OR=15.63, 95% CI (1.98-123.68), p=0.009] in the program sustainment model. Overall, these findings suggest the need for further exploration of program and workplace variables and provide evidence to consider incorporating partnership support and supportive coaching in real world implementation models to improve the likelihood of EBP implementation and sustainment in Indigenous communities.

A randomized controlled trial evaluating a low-intensity interactive online parenting intervention, Triple P Online Brief, with parents of children with early onset conduct problems

OBJECTIVE

This randomized controlled trial examined the efficacy of Triple P Online Brief, a low-intensity online positive parenting program for parents of children with early onset disruptive behavior problems.

METHOD

Two hundred parents with 2-9-year-old children displaying early onset disruptive behavior difficulties were randomly assigned to either the intervention condition (n = 100) or a Waitlist Control group (n = 100).

RESULTS

At 8-week post-assessment, parents in the intervention group displayed significantly less use of ineffective parenting strategies and significantly more confidence in dealing with a range of behavior concerns. These effects were maintained at 9-month follow-up assessment. A delayed effect was found for child behavior problems, with parents in the intervention group reporting significantly fewer and less frequent child behavior problems at follow-up, but not at post-assessment. All effect sizes were in the small to medium range. There were no significant improvements in observed negative parent and child behavior. No change was seen for parents' adjustment, anger, or conflict over parenting. Consumer satisfaction ratings for the program were high.

CONCLUSIONS

A brief, low-intensity parenting program delivered via the Internet can bring about significant improvements in parenting and child behavior.

Sustained Implementation of Evidence-based Programs in Disadvantaged Communities: A Conceptual Framework of Supporting Factors

This paper presents a review of the empirical literature for studies evaluating factors that facilitate and create barriers to sustained program implementation in disadvantaged communities. It outlines study methodology and sustainment outcomes and proposes a conceptual model that involves implementation sustainment support for providers delivering evidence-based health and family services in disadvantaged communities. Sustained program implementation in the community setting is a significant issue as only 43% of studies reported successfully sustained programs. The review identified 18 factors that facilitate success and create barriers to program sustainment. The factors are synthesized into three themes; program characteristics, workplace capacity, and process and interaction factors. The majority of factors map onto commonly cited sustainability influences in implementation science. However, there was an additional focus for studies included in this review on the importance of factors such as program burden, program familiarity and perceived competence in program skills, workplace support for the program, staff mobility and turnover, supervision and peer support, and ongoing technical assistance. The need to use a conceptual framework and develop measures to guide and evaluate capacity building in EBP implementation and sustainment in low-resource community settings is highlighted.

Social media and gamification: Engaging vulnerable parents in an online evidence-based parenting program

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than $15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online--a public health approach to protect and improve the development of vulnerable children.

Erratum to: Reducing Preschoolers' Disruptive Behavior in Public with a Brief Parent Discussion Group

The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Royalties stemming from this dissemination activity are distributed to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioural Sciences at UQ; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International. Karen Turner is an author of various Triple P programs.

Reducing preschoolers' disruptive behavior in public with a brief parent discussion group

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

Randomised clinical trial of a group parent education programme for Australian indigenous families

AIM

Parenting programmes have been shown to improve children's adjustment and reduce problem behaviour; however, little research has addressed outcomes for Indigenous families. The aim of this project was to assess the impact and cultural appropriateness of a parenting programme tailored for Indigenous families, an adaptation of the evidence-based Group Triple P - Positive Parenting Program.

METHODS

A repeated measures randomised group design methodology was used, comparing the intervention with a waitlist control condition pre- and post-intervention, with a 6-month follow-up of the intervention group.

RESULTS

Parents attending Group Triple P reported a significant decrease in rates of problem child behaviour and less reliance on some dysfunctional parenting practices following the intervention in comparison to waitlist families. The programme also led to greater movement from the clinical range to the non-clinic range for mean child behaviour scores on all measures. Effects were primarily maintained at 6-month follow-up. Qualitative data showed generally positive responses to the programme resources, content and process. However, only a small number of waitlist families subsequently attended groups, signalling the importance of engaging families when they first make contact, helping families deal with competing demands, and offering flexible service delivery so families can resume contact when circumstances permit.

CONCLUSIONS

This study provides empirical support for the effectiveness and acceptability of a culturally tailored approach to Group Triple P conducted by Child Health and Indigenous Health workers in a community setting. The outcomes of this trial may be seen as a significant step in increasing appropriate service provision for Indigenous families and reducing barriers to accessing available services in the community.

Does the triple P-Positive Parenting Program provide value for money?

OBJECTIVE

The aim of the present study was to investigate the economic case for the implementation of the Triple P-Positive Parenting Program on a population basis in Queensland, Australia, in order to reduce the prevalence of conduct disorder in children.

METHOD

Threshold analysis was undertaken together with a limited cost-effectiveness analysis.

RESULTS

The Triple P-Positive Parenting Program is a dominant intervention; that is, it costs less than the amount it saves, until the reduction in prevalence falls below 7% where net costs become positive.

CONCLUSIONS

Triple P is likely to be a worthwhile use of limited health funds. The economic case is promising, but further research is required to confirm the study results.

Help when it's needed first: a controlled evaluation of brief, preventive behavioral family intervention in a primary care setting

This study evaluated the effects of a brief 3- to 4-session behavioral family intervention program for parents of preschool-aged children in a primary care setting, compared to parents in a wait-list control condition. Parents receiving the Primary Care Triple P-Positive Parenting Program intervention reported significantly lower levels of targeted child behavior problems, dysfunctional parenting, and reduced parental anxiety and stress in comparison to wait-listed parents at postassessment. These short-term effects were largely maintained at 6-month follow-up assessment of the intervention group. Implications of these findings for the prevention of behavioral and emotional problems in children are discussed.

Reflections on the Challenges of Effective Dissemination of Behavioural Family Intervention: Our Experience with the Triple P - Positive Parenting Program

This paper draws on learnings from dissemination and diffusion research to discuss predictors of dissemination outcomes, obstacles to effective dissemination, and phases of dissemination failure. A model is presented of effective dissemination of a multilevel system of intervention known as the Triple P-Positive Parenting Program (Triple P). This model takes a systems-contextual approach, addressing program design, skills training, practitioner confidence and self-regulation, and workplace support. Recommendations are made for agencies adopting evidence-based programs, particularly in relation to the selection, establishment and maintenance of new programs as well as guiding ongoing program development. Future directions for research into the dissemination of evidence-based practice are also discussed.

The development and dissemination of the Triple P-Positive Parenting Program: a multilevel, evidence-based system of parenting and family support

This paper describes the theoretical and empirical basis of a unique multilevel system of parenting and family support known as the Triple P-Positive Parenting Program. The program incorporates five levels of intervention on a tiered continuum of increasing strength and narrowing population reach. The self-regulation framework of the program is discussed and an ecological or systems-contextual approach to dissemination of the program to service providers is highlighted. Implementation issues to consider in effective program dissemination are discussed including managing the "politics" of family support, strategies for coping with changes in government, maintaining quality, balancing cost and sustainability, and remaining data responsive. Future research directions are identified.