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The Triple P-Positive Parenting Program: A Systematic Review and Meta-Analysis of a Multi-Level System of Parenting Support
... Most studies were underpowered. The sample size in only seven studies (Gerber et al. 2016;Hayes et al. 2013;Keating et al. 2016;Lonergan et al. 2015;McMahon et al. 2023;Nitsch et al. 2015;O'Dwyer et al. 2025) was sufficient to provide adequate power (p = 0.05, β = 0.80) to detect a small to moderate effect size, which is typically found in parenting programs (Menting et al. 2013;Sanders et al. 2014). ...
... The effect size of 0.42 from our meta-analysis of 13 controlled studies of PP programs for child behavior problems compares favorably with those of 0.30 and 0.47 from meta-analyses of the Incredible Years (Menting et al. 2013) and Triple P (Sanders et al. 2014) parenting programs, respectively. Effect sizes from Menting et al. (2013) were based on controlled studies, while effect sizes from Sanders et al. were based on controlled and non-controlled studies. ...
... Most studies were underpowered, and there were low levels of father involvement. Studies were conducted by model developers or members of the PP professional network, which may have inflated effect sizes, although this variable did not inflate effect sizes in a metaanalysis of the Triple P program (Sanders et al. 2014). ...
This systematic review and meta‐analysis of Parent Plus (PP) Program evaluation studies aimed to update a previous meta‐analysis published in 2017. PP programs are systemic, solution‐focused, group‐based parent training interventions for the prevention and treatment of a range of child and adolescent problems. Controlled or uncontrolled, randomized or non‐randomized trials involving at least 10 cases which evaluated PP programs were included in the review. PsycINFO, PubMed, CINAHL, and ERIC databases were searched from January 2016 to January 2014. Risk of bias was evaluated with RoB2 and ROBINS‐I. Since the last meta‐analysis, the pool of PP studies has increased by 25%. This updated meta‐analysis included 21 studies involving 1179 families. In controlled trials, there were significant between‐group, post‐intervention effect sizes for child behavior (g = 0.42 [0.25, 0.59], p < 0.001, k = 13), goal attainment (g = 1.22 [0.83, 1.60], p < 0.001, k = 9), parental satisfaction (g = 0.67 [0.36, 0.98], p < 0.001, k = 8) and parental stress (g = 0.45 [0.20, 0.71], p < 0.01, k = 10) favoring PP programs. The main limitation of the review was the risk of bias in the primary studies reviewed. This updated meta‐analysis shows that PP programs are evidence‐based, systemic interventions that may lead to positive outcomes for families of children with emotional and behavioral problems, post‐divorce adjustment difficulties, intellectual disability, ADHD, and at risk of obesity.
Trial Registration: PROSPERO: CRD42024504594
... Parenting programs that focus on social learning and behavior change have demonstrated efficacy in the prevention and management of children's emotional and behavioral issues (de Graaf et al., 2008;Sanders et al., 2014). Parent training results in improved knowledge, more confidence, and effective caregiving (Hermenau et al., 2015(Hermenau et al., , 2017Holzer et al., 2006). ...
... One parenting intervention, the Triple P -Positive Parenting Program (Sanders, 2023), which was built on the premises of social learning theory (Hart & Risley, 1995), principles of applied International Journal of Child, Youth and Family Studies (2025) 16(1): 1-24 behavior analysis (Baer et al., 1968) and self-regulation theory (Bandura, 1986;Karoly, 1993), aims to improve parenting knowledge and skills and reduce negative behavioral, emotional, social, and developmental outcomes in children. Rigorous and extensive evidence for its effectiveness has been reported in many meta-analyses (de Graaf et al., 2008;Nowak & Heinrichs, 2008;Sanders et al., 2014). Triple P has been shown to reduce rates of child maltreatment (Prinz et al., 2022) and has been applied and proven effective in diverse countries and cultures, including Iran (Tehranidoost et al., 2008), China (Guo et al., 2016), Japan (Matsumoto et al., 2007), Switzerland (Bodenmann et al., 2008), Singapore (Zhou et al., 2017), and Australia (Turner et al., 2007). ...
... These findings are in line with research that shows parenting interventions that focus on positive parenting skills training are effective in improving mental well-being and a sense of self-efficacy among parents (Gray et al., 2018;), foster parents (Van Holen et al., 2018, and orphanage caregivers (Whetten et al., 2014). Other randomized controlled trials also suggest that the skills training provided in Group Triple P improves parental efficacy, satisfaction, and mental well-being (Bodenmann et al., 2008;Sanders et al., 2014). ...
An inadequate caregiving environment in an orphanage can negatively impact children’s well-being, while a lack of specialized training can induce work-related stress and lower self-efficacy among caregivers. This study examined the effectiveness of the Group Triple P (positive parenting program) with caregivers of children in Pakistani orphanages. Fourteen caregivers across three orphanages completed self-report questionnaires and took part in Group Triple P. A repeated measures ANOVA indicated that the personal well-being of the caregivers improved following intervention. There was also a significant increase in caregivers’ parenting efficacy and a decrease in the use of dysfunctional parenting practices. The frequency and number of children’s challenging behaviors was reported to decrease significantly, along with a significant increase in warmth and reduction in negativity in caregiver–child relationships. This study was the first to implement Group Triple P in an orphanage context. The outcomes support the use of an evidence-based parenting intervention with orphanage caregivers who are in a proxy parenting role.
... The FF I-study [37] was conducted as a randomized controlled trial, while the FF IIstudy [38] was a non-controlled open trial. Both studies aimed to evaluate the effectiveness of the Positive Parenting Program (Triple P; [39]). The motivation behind conducting the FF II-study was the underrepresentation of families from lower socioeconomic statuses in the FF I-study. ...
... The results of our prediction models provide hints that the approaches described could represent effective starting points for long-term preventive interventions. Participation in the Triple P program, in particular, appears promising, as it enhances parental competence, improves parent-child relationships, and strengthens children's mental health within a relatively short timeframe and over a longer period of time [39]. Parent training programs not only strengthen parenting practices and the parent-child relationship but also the parental partnership [39]. ...
... Participation in the Triple P program, in particular, appears promising, as it enhances parental competence, improves parent-child relationships, and strengthens children's mental health within a relatively short timeframe and over a longer period of time [39]. Parent training programs not only strengthen parenting practices and the parent-child relationship but also the parental partnership [39]. Safe, stable, and nurturing relationships-whether with parents, siblings, or other family members-along with overall family support and emotional warmth, may help break the cycle of maltreatment [27,28,50]. ...
Theoretical background
Adverse childhood experiences (ACEs) are strongly associated with mental and physical health problems across the lifespan, emphasizing the critical need for prevention. Sex-specific differences in both the prevalence and long-term consequences of ACEs have rarely been analyzed, especially in longitudinal studies, which are particularly needed.
Objective
This longitudinal study explores risk and protective factors as well as the intergenerational transmission of ACEs from parents to children, with a focus on sex-specific effects.
Methods
Data from 316 families participating in the 18-year German longitudinal project “Future Family” were analysed. The dataset included information from mothers (54 years), fathers (57 years), and their emerging adults (22 years).
Results
Daughters and mothers reported significantly more ACEs than fathers and sons, particularly in the categories of abuse and neglect. Experiencing four or more ACEs was associated with higher levels of psychological distress and lower life satisfaction for both parents and children. Approximately half of the emerging adults experienced a similar number of ACEs as their parents; however, the types of ACEs often differed, with children encountering distinct ACEs. Protective factors, such as higher maternal socio-economic status, maternal participation in the Positive Parenting Program (Triple P), and fewer internalizing problems in early childhood, were associated with a reduced number of ACEs in children by the age of 18.
Conclusion
Although women report higher rates of ACEs, men are not less affected in terms of psychological distress. Sex-specific considerations appear to be crucial in the prevention of ACEs and should be integrated into targeted strategies. Our findings highlight the importance of considering both parents’ perspectives in developing and implementing effective preventive interventions in families.
... The aim of such parent training is to strengthen the parental relationship and parenting skills to promote the healthy development of children. Several self-reflection exercises are used to train positive parental behavior [36,37]. ...
... The initial sample consisted of 280 families. Based on a randomized assignment, nearly half (48.6%) of the families received a brief parenting intervention (Triple P, [36]) after baseline assessment as part of the experimental condition (for details, see Hahlweg and Schulz [55]). Parents allocated to the control group were not provided with any training. ...
... This can be realized, e.g., by child-centered support programs [80] or parent training with low-threshold access for families with increased risk exposure. Cognitive-behavioral parent training has already been proven to be effective in this context [36]. ...
Background/Objectives: Developmental research has shown that mental health and functioning is determined by social background and child and family characteristics. Until now, there have been few longitudinal studies which considered several aspects at the same time and observed children’s development over ten or more years. Methods: The aim of this 18-year-longitudinal study is to find out to which degree different child, family, and socioeconomic factors during early childhood (4 years of age) are associated with educational and professional outcomes in young adulthood (22 years of age). Of the initial sample of 280 participating families, 225 could again be investigated with standardized interviews and questionnaires at the 18 years follow-up (retention rate: 80%). Results: Educational degree of the parents was predictive of the child’s school success (β = −0.267, p < 0.001, in regression analysis). Maternal mental health (β = −0.005, p = 0.953), parenting behavior (β = −021, p = 0.782), and early child mental health problems (β = 0.071, p = 0.551) only had a low impact. The child’s sex did not predict school success. Better early learned skills (i.e., crystalline intelligence), but not cognitive skills, as measured by the child-specific intelligence test K-ABC, made children more likely to achieve good school-leaving grades (β = −0.240, p = 0.008). Children’s early mental health problems had no relevant impact on school degree (d = 0.00, p = 0.934/d = 0.02, p = 0.52 3) or professional status (d = 0.04, p = 0.157/d = −0.02, p = 0.299) at age 22. Conclusions: Besides the not-changeable parental education level, (learnable) competency aspects may be more predictive of a child’s educational success until young adulthood than earlier mental health problems in parents and children. This is good news as it supports the idea that mental health deficits can be compensated for through learning and competency training.
... Lebih lanjut, apabila orang tua terlalu ketat, sering menggunakan kekerasan dan hukuman fisik, dan cenderung manipulatif antara lain membuat anak merasa takut dan bersalah, hal ini berdampak pada meningkatnya masalah-masalah perilaku pada anak seperti agresi (Pinquart, 2017). Mengajarkan strategi pengasuhan positif pada orang tua dapat membangkitkan rasa percaya diri orang tua dalam mengasuh anak, mengurangi stres yang dialami oleh orang tua, dan mengurangi pengasuhan yang bersifat negatif seperti melakukan kekerasan pada anak (Sanders et al., 2014). Perilaku bermasalah pada anak pun juga secara signifikan berkurang dan relasi orang tua dengan pasangannya juga semakin baik. ...
... Hasil penelitian pada 143 orang tua di Indonesia juga menunjukkan hal yang serupa. Tips pengasuhan positif yang diberikan melalui seminar kepada sekelompok orang tua (misal: menyiapkan lingkungan belajar yang aman dan menyenangkan, menetapkan aturan dan memberikan apresiasi atas perilaku anak yang baik, dan menyediakan waktu berkualitas untuk anak) dapat mengurangi munculnya perilaku bermasalah pada anak, menurunkan tingkat stres orang tua dan menambah kepercayaan diri dalam mengasuh anak (Sanders et al., 2014;Sumargi et al., 2015a). Pengasuhan orang tua yang kurang efektif, seperti memarahi, membentak, mengancam dan memukul anak menjadi berkurang dan kondisi ini berkorelasi dengan rendahnya tingkat perilaku bermasalah anak (Sumargi et al., 2015a(Sumargi et al., , 2015b. ...
... Orang tua menyatakan adana kebutuhan informasi terkait dengan strategi menghadapi perilaku bermasalah anak dan keinginannya untuk belajar mengenai pengasuhan positif melalui media tertulis (Sumargi et al., 2015b). Berdasarkan penelitian, pemberian tips pengasuhan positif dapat mencegah munculnya perilaku bermasalah pada anak karena orang tua cenderung membina relasi yang baik dengan anak, mengajarkan perilaku-perilaku positif pada anak, dan mengatasi perilaku bermasalah anak tanpa kekerasan (Sanders et al., 2014). Orang tua dapat memberikan konsekuensi logis pada anak seperti menarik kesukaan anak untuk sementara waktu dan memberikan kesempatan pada anak untuk mengelola emosinya (Sumargi et al., 2015a). ...
Menghadapi anak prasekolah bukanlah hal yang mudah karena anak seringkali menunjukkan perilaku bermasalah seperti merajuk dan marah-marah. Pendampingan orang tua kepada anak prasekolah menjadi semakin berat pada masa pandemi Covid-19 karena orang tua harus mendampingi anak dalam kegiatan belajar di samping menjalankan kegiatan rumah tangga dan pekerjaannya. Hal ini membuat orang tua menggunakan cara-cara pengasuhan yang tidak efektif kepada anak seperti membentak. Oleh karena itu, sangatlah penting untuk memberikan informasi kepada orang tua mengenai strategi pengasuhan positif guna mencegah dan mengatasi perilaku bermasalah pada anak. Hal ini dilakukan dengan memanfaatkan teknologi internet untuk menyebarluaskan e-booklet dan video animasi yang berisikan strategi pengasuhan positif kepada orang tua prasekolah. Mayoritas orang tua yang terlibat dalam kegiatan abdimas melaporkan bahwa mereka mengalami perubahan yang positif setelah membaca e-booklet dan/atau video animasi. Orang tua mendapatkan pemahaman baru mengenai strategi pengasuhan positif dan ingin menerapkan strategi tersebut. Dibandingkan dengan membaca e-booklet saja, orang tua melaporkan bahwa mereka mendapatkan lebih banyak manfaat dengan menonton video animasi. Orang tua menyarankan untuk memperbanyak ragam informasi mengenai pengasuhan anak dan menyebarkannya kepada lebih banyak orang tua.
... El programa posee una estrategia de 5 niveles que van disminuyendo su espectro de alcance a medida que aumenta la intensidad de la intervención, es decir, desde estrategias con enfoque poblacional hasta otras dirigidas a niños de alto riesgo o con condiciones específicas como la discapacidad. Incluye varios métodos de entrega según las necesidades de las familias (34)(35)(36). Triple P tiene una apuesta multidisciplinaria (34)(35)(36)(37), una aplicabilidad multicultural probada con estudios cuasiexperimentales y ensayos clínicos aleatorizados usando los niveles 2 y 4 (38-41), con aceptación de las familias, posibilidades de ajuste en los contenidos según el contexto (42) y que asegura una amplia disponibilidad (34)(35)(36)(37). ...
... Incluye varios métodos de entrega según las necesidades de las familias (34)(35)(36). Triple P tiene una apuesta multidisciplinaria (34)(35)(36)(37), una aplicabilidad multicultural probada con estudios cuasiexperimentales y ensayos clínicos aleatorizados usando los niveles 2 y 4 (38-41), con aceptación de las familias, posibilidades de ajuste en los contenidos según el contexto (42) y que asegura una amplia disponibilidad (34)(35)(36)(37). ...
... Incluye varios métodos de entrega según las necesidades de las familias (34)(35)(36). Triple P tiene una apuesta multidisciplinaria (34)(35)(36)(37), una aplicabilidad multicultural probada con estudios cuasiexperimentales y ensayos clínicos aleatorizados usando los niveles 2 y 4 (38-41), con aceptación de las familias, posibilidades de ajuste en los contenidos según el contexto (42) y que asegura una amplia disponibilidad (34)(35)(36)(37). ...
Introducción: la experiencia en el mundo de programas poblacionales de prevención del maltrato infantil es amplia, sin embargo, la eficacia científica aplica para pocos. La Society for Prevention Research y el Centro de Información para el Bienestar Infantil Basado en Evidencia de California lideran la cualificación de estas intervenciones. Objetivos: analizar la evidencia de los programas colectivos de prevención del maltrato con énfasis en Positive Parenting Program (Triple P) como una opción para implementar en jardines infantiles de Colombia. Metodología: se revisaron MEDLINE, PubMed, ELSEVIER, LILACS, desde las palabras MeSH “Child abuse”, “Child Maltreatment”, “Parenting Education”, “Prevention”, “Program Evaluation”. La búsqueda arrojó 2413 resultados y se incorporaron 76 artículos en el análisis de los programas preventivos del maltrato, profundizando en Triple-P. Conclusiones: los programas con mejores evidencias incluyen Incredible Years, Early Start, Nurse Family Partnership, Adults and Childrens Together y Triple P. Este último tiene alta eficacia y aceptación en entornos culturales diversos, se ha demostrado su eficacia mediante ensayos poblacionales con buenos resultados en indicadores distales. Triple P se identifica como una buena opción para disminuir el maltrato infantil desde su aplicación en instituciones educativas de la primera infancia en Colombia.
... However, our study further highlights the importance of reducing permissive parenting behaviors (e.g., difficulty disciplining the child, spoiling, and giving in to the child's demands) to better support the development of EF in children. Various parent training programs have been shown to be instrumental in enhancing parents' self-efficacy, parenting sense of competence, and ameliorating parental mental health problems [51][52][53]. Importantly, these programs have been associated with reductions in both behavioral and emotional problems in children, ultimately improving parent-child relationships [51,52]. ...
... Various parent training programs have been shown to be instrumental in enhancing parents' self-efficacy, parenting sense of competence, and ameliorating parental mental health problems [51][52][53]. Importantly, these programs have been associated with reductions in both behavioral and emotional problems in children, ultimately improving parent-child relationships [51,52]. In light of these findings, it is imperative to consider positive parenting programs as primary interventions in primary pediatric settings from early childhood onward [51]. ...
... Importantly, these programs have been associated with reductions in both behavioral and emotional problems in children, ultimately improving parent-child relationships [51,52]. In light of these findings, it is imperative to consider positive parenting programs as primary interventions in primary pediatric settings from early childhood onward [51]. By addressing parenting practices and supporting parental skills early on, such programs have the potential to not only improve resilience and self-regulatory efficacy, but also mitigate behavioral problems in children during their school years, thus fostering healthier parent-child relationships and promoting overall well-being. ...
Background
Longitudinal studies of associations between executive function (EF) and parenting behaviors during early childhood and resilience, self-regulation, and behavioral problems in school-age children are scarce. This study aims to evaluate long-term associations between EF and parenting behaviors during preschool and resilience, self-regulatory efficacy, and behavioral problems in 9-year-old children.
Methods
From February 2021-March 2022, 195 participants were enrolled from a larger longitudinal study conducted since age 6 months. Parents reported child EF difficulties and behavioral problems at ages 4, 6, and 9, as well as parenting behaviors at ages 4 and 6. Children reported resilience and self-regulatory efficacy at age 9. The relationships between these variables were analyzed using path analysis.
Results
Among 195 participants (51.3% female) with a median age of 108 months (interquartile range 108–109), EF difficulties at ages 4 and 6 exhibited direct and indirect relationships with lower resilience, reduced self-regulatory efficacy, and behavioral problems at age 9. Positive parenting at ages 4 and 6 were indirectly associated with better resilience, self-regulatory efficacy, and fewer behavioral problems at age 9, mediated by reduced EF difficulties and behavioral problems during preschool.
Conclusions
EF difficulties during preschool were correlated with decreased resilience, self-regulatory efficacy, and behavioral problems in school-age children. Interventions focusing on promoting EF and positive parenting during early childhood may alleviate behavioral problems and potentially enhance resilience and self-regulatory efficacy during school-age.
... Pueden contribuir a ello la actitud en la crianza de los propios progenitores y también la existencia de una red social activa y de activos de salud 50-63 , la capacidad de búsqueda de apoyos por parte de padres o hijos, la mejora de los vínculos paternofiliales e interpersonales y los programas de visita domiciliaria 50,63-68 . También programas más específicos, tales como los grupos de apoyo mutuo, de crianza positiva, de entrenamiento en la resolución de problemas, y otros muchos ya practicados e investigados, que muestran buenos resultados a largo plazo, promoviendo el bienestar del niño, de los padres y de la familia 63,69 . ...
... También poseemos numerosas evidencias acerca de los programas de visita domiciliaria de tipo psicosocial, cuya eficacia, efectividad y eficiencia han sido probadas en numerosos lugares, culturas y enclaves [64][65][66][67][68] . Los objetivos de las intervenciones preventivas en esta población son: 1) la mejora de los factores de protección para amortiguar la exposición de los niños a estos entornos de riesgo (tabla 5); 2) fortalecer sus mecanismos de afrontamiento; 3) fortalecer su estabilidad y desarrollo emocional, y 4) ampliar y mejorar su conectividad o red social, con lo cual se reducen la incidencia, la prevalencia y la recurrencia de los trastornos mentales, así como la discapacidad asociada 23,62,63,69 . ...
... Por ejemplo, sobre qué intervenciones son más efectivas según el tipo de trastorno mental diagnosticado en la figura parental, cuán de tempranas, aunque a ser posible precoces, han de ser las intervenciones preventivas 6,10,43 , y sobre si el hecho de que ambos padres o cuidadores o solo uno de ellos sufra un trastorno mental influye en el posible resultado preventivo de la intervención [69][70][71] . Sin embargo, todos los resultados indican la urgente necesidad de generar políticas sociales y de salud pública que articulen intervenciones preventivas efectivas para estas familias 23,[61][62][63] . ...
La crianza y el desarrollo psicosocial de los hijos que viven con padres con trastornos mentales graves (esquizofrenia y trastornos delirantes, depresión mayor, episodio de manía, intentos de suicidio, trastornos graves de la personalidad, alcoholismo o abusos de otras drogas y otros trastornos) pueden ser más difíciles, y su calidad de vida, sus relaciones y su salud mental pueden verse seriamente afectadas. Conseguir un cierto conocimiento en la práctica clínica que facilite la recogida y la investigación de antecedentes psiquiátricos de los padres y
la identificación de factores de riesgo y senales ˜ de alerta elementales en los ninos ˜ supone una mejoría en las capacidades de los equipos de Atención Primaria de Salud (APS) para integrar los elementos de salud mental en su práctica cotidiana. Se trata, además, de un paso previo imprescindible para poner en marcha intervenciones preventivas, al menos elementales, necesarias para la protección de la salud mental de esos ninos ˜ y futuros adultos: ese es el núcleo de
este subprograma del PAPPS para el cuidado de la salud mental de los ninos ˜ y de los adolescentes en el caso de antecedentes de psicopatología en los progenitores o cuidadores
... These factors may have biased results in favor of the intervention group. On the other hand, previous research on parenting programs has indicated that parent-report measures may not be as sensitive as researcher-ratings in detecting change, particularly in shorter interventions [44]. ...
... This precluded conducing per protocol analyses. Future PP-HF trials should collect data on session attendance and between-session home practice task completion as both of these variables have been found to moderate the effectiveness of lifestyle interventions [15] as well as parenting interventions in general [44]. ...
Background:
Childhood obesity is a global public health concern. In Ireland, the age standardized prevalence rates for obesity in children and adolescents are about 1% higher than the average for countries in the WHO European Region. The Parents Plus Healthy Families program (PP-HF), an 8-week, group-based, multicomponent parent training intervention, was designed to prevent childhood obesity by helping parents promote healthy habits within their families.
Methods:
A multisite cluster randomized controlled trial was conducted to investigate the effectiveness of the PP-HF program across 16 community-based and clinical settings. Sixty-eight parents were assigned to the PP-HF group and 70 were assigned to the treatment as usual (TAU) control group. Parents completed measures assessing healthy habits, child lifestyles behaviors, parental lifestyle-specific self-efficacy, parental satisfaction, family dysfunction, and child behavior problems at baseline and post-intervention. Parents in the PP-HF group completed measures at 6-weeks follow-up.
Results:
Multi-level modelling analyses demonstrated that post-intervention, compared to the control group, parents in the PP-HF condition reported significant improvements on measures of healthy habits, parental satisfaction, family-functioning, and child behavior problems. Gains were maintained at 6-weeks follow-up. No change was observed on measures of child lifestyle behaviors, or parental lifestyle specific self-efficacy compared to the control group.
Conclusion:
The PP-HF program may be effective in improving healthy habits, parental satisfaction, family functioning, and child behavior problems among families with children aged 2-12 across both clinical and community settings.
Trial registration:
This trial was retrospectively registered on Open Science Framework on 11.th April 2023. Registration DOI: https://doi.org/ https://doi.org/10.17605/OSF.IO/4PY63.
... Social contexts and black families' engagement in early childhood programs visiting programs targeting the caregivers of newborns and young children [2]. High-quality home visiting can reduce maternal and child mortality [3], improve maternal mental health [4][5][6][7], and strengthen parent-child interactions [4,5,8,9]. ...
... Social contexts and black families' engagement in early childhood programs visiting programs targeting the caregivers of newborns and young children [2]. High-quality home visiting can reduce maternal and child mortality [3], improve maternal mental health [4][5][6][7], and strengthen parent-child interactions [4,5,8,9]. ...
In the U.S., the federal government and dozens of cities have invested in home visiting programs intended to be universally available at scale to support caregivers of young children. Evaluations find that participation in these programs reduces maternal mortality, improves maternal mental health, and supports children’s healthy development. Yet, many parents of young children who are invited to participate in home visiting programs do not enroll. This study fills gaps in the literature by examining how the broader social context affects Black families’ engagement in home visiting programs. Via focus groups, survey data from a socioeconomically diverse sample of Black parents across the U.S., and a pre-registered field experiment, we capture views of and experiences with early childhood home visiting programs. We assess the responsiveness of these views to the broader social context and examine implications for interest and participation in home visiting programs. Focus group participants described benefits of home visiting while also expressing concerns about being unfairly judged about their parenting practices and the risk of a home visit resulting in child welfare system involvement. One out of four Black parents surveyed associated the term “home visit” with surveillance (i.e., government scrutiny of parenting), and associating “home visit” with surveillance was empirically correlated with lower participation in home visiting programs. Further, our pre-registered survey experiment showed a causal link between surveillance fears and home visit engagement. Reading a news article about a family’s experience with the child welfare system decreased interest in home visiting among Black parents, while labeling a program as “new baby wellness” rather than “home visit” increased interest. Collectively, the findings point to ways in which the broader social context of parenting/parental surveillance negatively affects Black parents’ participation in early childhood home visiting programs despite their interest.
... For example, the Confident Parents Belgium programme guided parents of young children (aged 3-6) with externalising problems through 8-week intervention sessions and saw parents with greater PSE reporting significant reductions in their child's externalising problems, with moderate-large effect sizes (d = 0.62) [23]. Similarly, a meta-analysis of 30 years of the Triple P Parenting Program demonstrated improvements in PSE led to improvements in fathers' parenting practices (d = 0.35) and subsequent child socio-emotional wellbeing outcomes (d = 0.38), with small to medium-sized effects [36]. Therefore, these intervention studies are promising in demonstrating the modifiable and influential nature of PSE on child mental health. ...
... This current study offers several practical implications for promoting positive child mental health development in communities. First, our findings of increased father self-efficacy being linked with decreased child mental health difficulties supports the promotion of parenting interventions for fathers such as the Triple P, Confident Parents, and Dads Tuning in to Kids programmes, as presented earlier [23,36,54]. Our findings suggest that these parenting interventions should target fathers low in parental self-efficacy, those high in permissive parenting, and those experiencing difficulties in parent emotion regulation. ...
Improving parental self-efficacy has been linked with reductions in child mental health difficulties; however, underlying mechanisms remain unclear, especially for fathers. This study investigated whether father self-efficacy influences child mental health difficulties indirectly through parenting style and parent-facilitated regulation of children’s negative emotions. A community sample of American fathers (N = 350, M = 39.45 years old) completed self-reports on father self-efficacy, parenting styles, parent-facilitated emotion regulation, and their children’s mental health difficulties (aged 4–12). Path analysis was used to test a cross-sectional, parallel–sequential indirect effect model. Father self-efficacy had a significant indirect effect on child mental health difficulties via three significant pathways of permissive parenting, authoritative parenting–acceptance of child’s negative emotions, and authoritarian parenting–avoidance of child’s negative emotions. Our model explained a moderate amount of variance in child mental health difficulties. The findings support promoting father self-efficacy through parenting interventions and highlight parenting beliefs as important for clinicians providing child mental health care.
... Furthermore, family pressures are likely influenced by other factors such as parental mental health problems, financial instability, and drug or alcohol dependence [73]. Interventions and policies that address such issues, such as parenting programs (e.g., Triple P, [74]) and access to affordable mental health support, may therefore play an important role in preventing and reducing self-harm among young people. ...
The last decade has seen a steady rise in self-harm rates in young people in developed countries. Understanding the experience of self-harm in young people can provide insight into what may be driving this increase. The aim of the current review was therefore to synthesise qualitative research examining precipitating and motivating factors underlying self-harm in young people. PsychInfo, Embase and Medline were systematically searched for articles published up to September 2024. A total of 50 qualitative studies (study N ranging from 3–115) were identified, and key findings were synthesised using Attride-Stirling’s Thematic Network Analysis process. The quality of included studies was assessed using a modified version of two Joanna-Briggs Institute Checklists. Control was identified as a global theme. Precipitants were informed by young people’s perception of an absence of control and the desire to gain control was identified as an underlying motivation for self-harm. The findings from this review highlight the need to support and educate young people to improve their distress tolerance, particularly in respect to situations outside of their control. Furthermore, therapeutic interventions, and training and educational programs targeting young people who self-harm and their family members might be effective interventions for self-harm in young people.
... Regarding increasing access to parenting programs, many existing interventions are designed to target specific clinical populations (e.g., parents of children with specific behavioural profiles or clinical diagnoses; [81]). In contrast to this trend, there is growing evidence for admitting parents to programs based on transdiagnostic features, such as parent or child ER difficulties [1]. ...
This study examined the effectiveness of the Parenting CARE Program, a virtual, synchronously delivered parenting intervention aimed at improving child emotion regulation (ER) by enhancing parental ER and emotion socialization (ES) skills. In a pilot randomized controlled trial, 105 parents of children aged 8 to 13 were randomly assigned to the intervention group (n = 57) or control group (n = 48). Two-way mixed ANOVAs were used to evaluate changes in parental ES, parental ER, and child ER from T1 to T2. A significant interaction between time and group was found for overall parent emotion dismissing scores, showing a greater decrease in parents’ dismissing responses to their child’s emotions for the intervention group compared to the control group. The difference between intervention and control emotion dismissing scores was observed to be approaching significance at T2. No significant time x group interactions were observed for overall supportive ES behaviours, parent ER difficulties, or child ER difficulties, despite improvements observed over time for the intervention group across parent and child ER difficulties. Secondary analyses revealed significant reductions in punitive and overriding ES behaviours for the intervention group, compared to the control group. The intervention demonstrated feasibility, with 75% of participants completing at least four sessions, and high satisfaction rates were reported by participants. These findings suggest potential benefits of the intervention in improving parent ES, parent ER, and child ER, although further research is needed to explore long-term effects.
... Positive parenting tends to refer to parenting that includes more sensitivity and warmth and appropriate discipline, such as inductive reasoning (Proctor & Brestan-Knight, 2016) and assertive discipline without the use of physical discipline (Holden et al., 2017). For example, the Triple P-Positive Parenting program focuses on shaping desirable behavior through communication, ground rules, consistency, positive reinforcement, empathy, and discipline, such as time-out or natural consequences; this approach is effective at improving parenting practices and child outcomes (see Sanders et al., 2014 for a meta-analysis). On the other hand, power assertive discipline refers to harsh verbal discipline (e.g., yelling, namecalling) and harsh physical punishment (e.g., smacking, yelling). ...
Although researchers have speculated about why education relates to parenting practices, such as spanking, there is very little direct evidence for why this relation exists. This study examined the relation between education and parent discipline beliefs in a novel way by comparing college freshmen and seniors at a large public university, thus allowing for a clear comparison of education groups before adults become parents and lower education becomes a proxy for something else (e.g., higher stress) in predicting child outcomes. We examined differences in freshmen and seniors’ beliefs about parent discipline as well as predictors of those beliefs, reasoning that courses taken or changes in thinking style may predict beliefs about discipline. We examined students’ (N = 600) views on punitive discipline using several measures and found that freshmen were significantly more likely than seniors to endorse spanking, harsh discipline, and spanking of all age groups but infants, controlling for participant age, parents’ education, and spanking experienced as a child. However, we found no significant difference in thinking style (i.e., postformal thought, need for cognition) controlling for these variables. In a regression predicting composite punitive discipline, level of education and courses taken covering discipline were significant predictors. These results suggest college coursework is a novel determinant of parenting beliefs before young adults become parents, which has practical implications for promoting the parenting practices we know relate to positive child outcomes.
... where a parent learns tools and techniques that they can use at home to help their child; Jewell et al., 2022) are commonly delivered for preadolescents with EBP (Ludlow et al., 2020), have been shown to be effective, and can be delivered in ways that require less therapist time than childfocused approaches (e.g. Sampaio et al., 2018;Sanders et al., 2014;Thirlwall et al., 2013), indicating their potential to help increase access to treatment for preadolescent children with EBP. They can also help to reduce perceived stigma for children and parents; for example, parents have identified not wanting their child to feel as though they have a problem or not wanting other people to know about their child's difficulties as reasons for not seeking help . ...
Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child’s symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.
... [31] The history of positive parenting research ranges from case-controlled studies in the early 1980s to randomized controlled trials (RCTs). [32] The meta-analyses conducted in this regard have shown medium to large effect sizes on parent and child outcomes. [33][34][35] However, although parent behavioral training programs, including positive parenting, are considered the gold standard for treating a variety of children's behavioral problems and psychopathology, there is evidence that this type of treatment is not always sufficient and has limitations. ...
BACKGROUND
The onset age of mental disorders such as depression is usually in childhood and adolescence, therefore, effective preventive strategies and early intervention for mental disorders have the potential to significantly reduce the burden of disease globally and improve the lives of people with mental disorders. In this regard, the present study aimed to comparison the effectiveness of parenting acceptance and commitment therapy (PACT) with triple-P Positive Parenting on depression, aggression, and social skills in children and then compare it with positive parenting.
MATERIALS AND METHODS
The current study was a randomized clinical trial design with two intervention and one control group with three-month follow-up. The population includes children aged 5 to 7 years from the 4 th district of Tehran. Fifty-two children that meet selection criteria was selected by purposeful sampling method. They were randomly assigned to two intervention groups and one control group using a simple randomization method via a lottery. Child Anxiety and Depression Scale-Parent Form (RCADS-P-25), Aggression Scale for Preschool Children, and Social Skills Rating Systems (SSRS) were administered in the baseline, post-test, and follow-up stages. The positive parenting experimental group received group therapy during eight two-hour weekly sessions, and the parenting of the acceptance and commitment therapy group received group therapy during eight two-hour weekly sessions . Data were analyzed using multivariate analysis of the covariance test.
RESULTS
The results of the multivariate analysis of covariance show that there is a significant difference between the intervention group based on parenting acceptance and commitment and the control group in the post-test and follow-up stages in the measured variables, including depression, aggression, and social skills ( P < 0.001). Additionally, the results of the multivariate analysis of covariance showed that there is a significant difference between the positive parenting group and the control group in the post-test and follow-up stages in the measured variables ( P < 0.001). In addition, the results show that there is no significant difference in the measured variables between the PACT and positive parenting groups in the post-test and follow-up phases ( P > 0.05).
CONCLUSION
In conclusion, the results of the current study show that both parenting approaches based on PACT and positive parenting are effective on children’s depression, aggression, and social skills. Therefore, it is recommended that child counselors and psychotherapists use the findings of this study in line with clinical and therapeutic interventions to help children’s problems.
... Positive childhood experiences, such as high-quality parental relationships, were positively linked to adult SFWB, whereas adverse childhood experiences, such as parental divorce and financial difficulties, were associated with lower financial well-being in adulthood. These positive associations align with previous research showing that children raised in warm, supportive parenting environments are more likely to experience greater well-being in adulthood and are less likely to develop antisocial behaviours, even in the face of economic deprivation 31,[62][63][64] . Conversely, the negative associations observed in this study add to existing evidence on the detrimental effects of socioeconomic deprivation and family disruption on emotional well-being 34 . ...
Using nationally representative data from 202,898 participants in the Global Flourishing Study, this work examines factors associated with financial well-being across 22 countries. We investigate how demographic factors—including age, gender, marital status, employment status, education, religious service attendance and immigration status—are correlated with financial well-being (as assessed through four dimensions). Additionally, we analyse associations between recalled early-life conditions, such as parental marital status and childhood health, with financial well-being in adulthood. Our findings reveal cross-national differences in levels of financial well-being and its demographic correlates. Early-life conditions were also consistently associated with adult financial well-being, although these associations varied substantially across countries. These results suggest that understanding financial well-being should encompass both current sociodemographic factors and early-life experiences within the unique cultural and socioeconomic contexts of different populations.
... N = 6 Familien wurden nicht erneut befragt, da sie die Einschlusskriterien nicht erfüllten, und n = 2 junge Erwachsene waren bereits verstorben. Das mittlere Alter der jungen Erwachsenen betrug 22,3 Jahre (SD = 1,2; Range: [19][20][21][22][23][24][25][26], 50 % waren männlich. Weitere Angaben zur untersuchten Stichprobe sowie ...
Zusammenfassung
Einleitung
Mit dem neuen Cannabisgesetz wurde am 01.04.2024 der Konsum von Cannabis legalisiert. Bereits zuvor war Cannabis eine der am häufigsten konsumierten Drogen. Ein problematischer Konsum birgt jedoch vielfältige gesundheitliche Risiken, besonders für Jugendliche und junge Erwachsene. Die aktuelle Studie untersucht die Entwicklung des Cannabiskonsums vom Jugend- zum jungen Erwachsenenalter sowie Risiko- und Schutzfaktoren für einen problematischen Konsum bei jungen Erwachsenen.
Methoden
Die Daten stammen aus der deutschen Längsschnittstudie „Zukunft Familie“ (Start: 2001, 18-Jahres-Follow-up: 2020–2022). Die Stichprobe umfasst N = 278 junge Erwachsene ( M = 22,3 Jahre). Betrachtet werden Prävalenzraten und die Entwicklung des Cannabiskonsums vom Jugend- zum jungen Erwachsenenalter. Als mögliche Risiko- und Schutzfaktoren für einen problematischen Konsum werden verschiedene kind- und familienbezogene Variablen des Kindergarten- und Jugendalters untersucht.
Ergebnisse
Die Lebenszeitprävalenz für Cannabiskonsum betrug 57,6 %, die Prävalenz für problematischen Konsum 13,7 %. Junge Männer hatten ein 3,3-fach höheres Risiko für einen problematischen Konsum als junge Frauen und junge Erwachsene, die bei der Befragung im Jugendalter bereits Cannabis konsumiert hatten, ein 2,6-fach höheres Risiko. Als Risikofaktor für einen problematischen Konsum erwies sich primär das Ausmaß externalisierender Verhaltensauffälligkeiten im Jugendalter aus Muttersicht.
Diskussion
Die Ergebnisse bestätigen, dass Cannabiskonsum sowie ein problematischer Konsum bei jungen Erwachsenen bereits vor der Legalisierung kein seltenes Phänomen waren. Sie unterstreichen die Notwendigkeit für verhältnis- und verhaltenspräventive Maßnahmen und bieten zahlreiche Ansatzpunkte für die zukünftige Forschung.
... While secondary and tertiary prevention efforts focus on mitigating harm after child maltreatment has occurred, primary prevention is essential in addressing risk factors before abuse or neglect begins. Primary prevention strategies, which seek to strengthen family systems, are particularly effective in reducing child maltreatment and promote positive childhood experiences (Sanders et al., 2014). Bronfenbrenner's Ecological Systems Theory (1979) emphasizes the critical role of family as the primary context for a child's development, highlighting how supportive familial environments contribute to overall well-being. ...
The article emphasizes the importance of strengthening India's child protection system by incorporating NGOs to deliver crucial elements, particularly those that fortify families. The Ministry of Women and Child Development initiated Mission Vatsalya to ensure the well-being of children with an emphasis on family-oriented care. As the principal body for child protection, the ministry encompasses a variety of policies, laws, and initiatives aimed at safeguarding children. However, over the years, the child protection system in India has faced varied challenges in realizing its full potential. The authors review the positive aspects and propose methods for more efficient and rapid implementation. Additionally, the article illuminates the role of NGOs in executing and providing family-centered interventions to prevent child maltreatment. It discusses the role of NGOs as effective facilitators in the application of government policies, illustrated by several examples. The article concludes by advocating that evidence based child welfare policies should be recognized to combat child maltreatment.
... Positive childhood experiences, such as high-quality parental relationships, were positively linked to adult SFWB, whereas adverse childhood experiences, such as parental divorce and financial difficulties, were associated with lower financial well-being in adulthood. These positive associations align with previous research showing that children raised in warm, supportive parenting environments are more likely to experience greater well-being in adulthood and are less likely to develop antisocial behaviours, even in the face of economic deprivation 31,[62][63][64] . Conversely, the negative associations observed in this study add to existing evidence on the detrimental effects of socioeconomic deprivation and family disruption on emotional well-being 34 . ...
Using nationally representative data from 202,898 participants in the Global Flourishing Study this work examines factors associated with financial well-being across 22 countries. We investigate how demographic factors—including age, gender, marital status, employment status, education, religious service attendance, and immigration status—are correlated with financial well-being (as assessed through four dimensions). Additionally, we analyze associations between recalled early-life conditions, such as parental marital status and childhood health, with financial well-being in adulthood. Our findings reveal cross-national differences in levels of financial well-being and its demographic correlates. Early-life conditions were also consistently associated with adult financial well-being, though these associations varied substantially across countries. These results suggest that understanding financial well-being should encompass both current socio-demographic factors and early-life experiences within the unique cultural and socioeconomic contexts of different populations.
... The FF-I-study was a randomized controlled trial, while the FF-II-study was an open trial without a control group. Both studies evaluated the effectiveness of the Positive Parenting Programme (Triple P; Sanders et al., 2014) among families with kindergartenage children. The primary reason for conducting the FF-II-study was the underrepresentation of families with a low SES in the FF-I-study. ...
The few German studies on children, adolescents, and young adults with a migration background (MB) suggest a slightly greater burden compared to those without an MB. This difference is likely influenced by risk factors such as poorer living conditions and lower socio-economic status (SES). This study compares children with and without an MB (N = 316) at three assessment points over 18 years regarding mental health problems, substance use behaviour, and school and professional qualifications: in kindergarten, adolescence, and young adulthood. Young adults with an MB exhibited significantly more symptoms of depression and anxiety, poorer mental health, less social support, and more frequent risky alcohol and tobacco use compared to those without an MB. These differences persisted even when controlling for SES. The MB was found to be the most important predictor of mental health problems in young adulthood. Future studies should consider the heterogeneity of migrants.
... There are significant differences among various PMIs in terms of their implementation frameworks and intervention goals. For example, family-based interventions such as the Research Units in Behavioral Intervention (RUBI) (Bearss et al., 2018) and the Positive Parenting Program (Triple P) (Sanders et al., 2014) focus primarily on improving children's behavioral problems through behavioral management and parent training. Parent-child interaction therapy (PCIT) (Vess & Campbell, 2022) can also be implemented in natural settings, but its core objective is to enhance behavioral management and improve parent-child relationships through parent-child interactions. ...
Autism spectrum disorder (ASD) is a developmental disorder that warrants early intervention. This systematic review evaluated the efficacy of parent-mediated natural developmental behavioral interventions (NDBIs) for children aged 0–6 with ASD across various randomized controlled trials (RCTs) and explored the limitations of these interventions. A systematic search was conducted across the PubMed, Web of Science, Embase, and Scopus databases to identify RCTs, and the selected studies were assessed for quality. The search was conducted through January 2024 and identified eight RCTs that, despite varying methodological rigor, collectively suggest benefits for social communication, language skills, and parent‒child interactions in individuals with ASD. Future research should implement standardized intervention protocols, employ sensitive assessment tools, and provide detailed statistical analysis plans to improve the generalizability and reliability of the outcomes of this study.
... Mempersiapkan calon orang tua dengan pendidikan parenting dapat membantu meningkatkan kemampuan mereka dalam mengasuh anak dan mencegah terjadinya masalah dalam pengasuhan (Belsky J & Jaffee SR, 2006). Selain itu, terdapat penelitian menunjukkan bahwa pendidikan parenting dapat meningkatkan parenting sense of competence dan mengurangi tingkat stres pada orang tua (Girard et al., 2017;Sanders et al. 2014). ...
Di Indonesia masih banyak ditemukan kasus-kasus yang berkaitan dengan perasaan tidak kompeten selama proses pengasuhan anak atau yang biasa disebut dengan parental sense of competence (PSOC). Perasaan tidak kompeten selama proses pengasuhan dapat mempengaruhi tumbuh kembang anak nantinya. Hal ini bisa diantisipasi salahsatunya dengan mempersiapkan calon orangtua untuk memiliki perasaan kompeten dalam pengasuhan. Penelitian ini dilakukan dengan tujuan melihat dampak dari pemberian psikoedukasi parenting education terhadap parental sense of competence di dewasa awal untuk mempersiapkan sebagai orangua dalam upaya peningkatan kemandirian dan Kesehatan mental keluarga. Penelitian ini menggunakan metode eksperimen one group pretest-posttest, dengan jumlah responden 49 orang yang memiliki kriteria usia dewasa awal, belum menikah dan belum memiliki anak. Data dikumpulkan dengan menggunakan kuisioner PSOC yang diadaptasi dari alat ukur PSOC milik Gibaud-Wallston & Wandersman dengan skor validitas antara 0,25-0,74 (<0,25), dan skor reliabilitas sebesar 0,726. Data yang telah terkumpul dianalisis menggunakan teknik analisis data paired sample t-test dengan bantuan SPSS 27. Hasil dari pengujian diperoleh skor signifikansi sebesar 0,036 (<0.05) yang artinya hipotesis diterima, yaitu terdapat dampak parenting education terhadap parenting sense of competence dalam mempersiapkan dewasa awal menjadi orangtua.
... It is, therefore, important to interrupt the transmission of factors associated with heightened risk of poor health or social outcomes across generations following a TPE in order to address systematic socio-inequalities related to these events. Access to parenting support initiatives and early childhood home visiting programs, such as Triple P (Sanders et al., 2014) and Family Connects (Dodge et al., 2019), have demonstrated a role in improving family wellbeing after adversity. Future studies of TPEs could consider aspects of marginalized populations, such as ethnicity or race that could also highlight pertinent prevention measures. ...
Introduction: Some individuals over their life course will experience significant health-related events, such as a physical or mental illness, that can alter their life pathways or trajectories, known as “turning-point” events. This systematic review aimed to synthesize the evidence from population-based data collections for: (a) parent health-related turning point events and the impact of these events on offspring health and social outcomes; and (b) offspring health-related turning point events and the impact of these events on parent health and social outcomes. Method: A review of four databases (MEDLINE, CINAHL, PsycINFO, and Scopus) from January 1, 2010 to February 23, 2023 was conducted. Abstracts and full-text articles were screened by four reviewers and critically appraised. Results: Of 114 articles, 98 (86%) examined the effect of a parental health-related turning point on offspring, 11 (10%) examined the effect of an offspring turning point on parents, and five (4%) investigated bidirectional impacts of a turning point event. For parents and offspring, mental health disorders (50%), physical health (26%), and death (24%) were common turning point events examined. For parents and offspring, common health outcomes included mental disorders (n = 50), physical health (n = 11), substance use (n = 9), and death (n = 7), and common social outcomes included educational performance (n = 14), employment or income level (n = 7), and involvement of child protective services (n = 5). Discussion: The ability to disentangle relationships between turning point events and adverse health and social outcomes is required, as is the development of strategies to disrupt intergenerational disadvantage.
... While a direct focus on household (dis)organization does not appear to be a central element of parenting interventions, many (e.g., Positive Discipline in Everyday Parenting (Durant, 2016) and Triple P (Sanders et al., 2014) do include the development of routines related to 'pressure points' within the family, such as getting ready for school or bedtime. This may be insufficient to meet the needs of families when disorganization is extreme (see commentary by Scott et al., 2001). ...
Parenting stress can be detrimental to child outcomes and there is evidence that both parental fatigue and household chaos are associated with the stress experienced by parents. There has been little investigation of the relative contributions these variables make to stress and even less consideration of the changes that may occur in the impact of and associations among these variables as children mature. This study explored the contribution of fatigue and household chaos to parental stress in a large sample of Australian mothers of children and adolescents. Participants completed the Parental Stress Scale, the Fatigue Assessment Scale and the Confusion, Hubbub and Order Scale. There was no group difference on the measure of stress. While parents of young children reported slightly higher levels of fatigue and household chaos than those of adolescents, effect sizes were small. Household chaos contributed to maternal stress over and above the impact of fatigue; however, there was a complex interaction between the effect of chaos and fatigue on stress. As the level of chaos increased, the impact of fatigue on maternal stress decreased. This interaction was not moderated by child age. As the data were collected during the COVID-19 pandemic, our considerations of the results of the study include some speculation about the influence of this on our results.
... Extensive evidence of best practice in relation to child development, early childhood education and care and early parenting contributes to an expansive field of knowledge which supports and promotes the health and wellbeing of children and families (McCoy et al., 2017;Sanders et al., 2014;Shonkoff et al., 2000). Support provided to families, by EPCs, and outcomes during the early years is currently not formally documented, included or evaluated in this evidence base. ...
Tracking, measuring, and reporting outcomes fosters improvement and adoption of best practices. It enables identification of what is and is not working and can contribute towards greater effectiveness and efficiency in the delivery and engagement of programs and interventions. The early years of a child’s life significantly influence life-long health and wellbeing, learning and behaviour outcomes. Due to the complexity of parenting during the early years of a child’s life many parents and caregivers seek support and guidance to improve their parenting knowledge and confidence. In Victoria, Australia, Early Parenting Centres support families with their parenting practices through a range of programs. Evidence of the impact of Early Parenting Centres programs has been limited with minimal data collected focusing on the outcomes of Early Parenting Centres program involvement and delivery. To gain a detailed understanding of the impact of Early Parenting Centres programs the development of a Victorian Early Parenting Centres Outcomes Framework was commissioned. This paper provides a methodological roadmap for Outcomes Framework and Implementation Plan development which is underpinned by co-creating Knowledge Translation Framework and Integrated Knowledge Translation and exchange approaches. Steps one to three of the co-creating Knowledge Translation Framework were utilised and resulted in the development of an Outcomes Framework and Implementation Plan for the Victorian Early Parenting Centres sector. Additionally, this blueprint of outcomes framework development addresses a significant gap in the literature—the lack of guidance, research, and clarity in developing an Outcomes Framework for Early Parenting Centres.
... Parenting interventions may also look to educate parents on how their approach to parenting, such as hostile parenting, is associated with additional risk for their child to get involved in crime. A number of evidence-based parenting programs, such as Triple P positive parenting program and Staying Connected with your Teen/Parents Who Care, offer educational messaging that could be added to youth crime prevention programming (Haggerty et al., 2007;Sanders et al., 2014). This focus need not require the development of new interventions, as social components could be added to curricula that, to date, have been more squarely focused on individualistic considerations (e.g., self-control). ...
Objectives
We draw on social learning theory to examine associations between parents’ attitudes, beliefs, and behavior and youth crime. Extending beyond prior work in the social learning tradition, we expand the scope of attitudes and beliefs that may elevate youths’ risk, recognizing that most interactions and communications involve noncriminal considerations.
Methods
Using longitudinal data from the National Survey of Teen Relationships and Intimate Violence ( n = 1,162), we explore the direct and indirect role of parental attitudes and behaviors on individuals’ self-reported crime using structural equation models.
Results
Our findings provide support for a social learning approach and demonstrate the ongoing role of parents through late adolescence to adulthood via direct and indirect pathways. We find that parental behaviors are associated with youths’ involvement in crime. In addition, parental influence processes help to shape youths’ own developing attitudes which, in turn, contribute to their risk of offending.
Conclusions
These findings underscore the need to direct additional attention to family influence processes to develop a comprehensive understanding of youth involvement in crime and to inform the development of programmatic efforts focused on disrupting the process of intergenerational transmission.
... Research consistently highlights that spousal support, dyadic coping, and marital satisfaction are negatively associated with parenting stress (Brown et al., 2020;Durtschi et al., 2017;Grau et al., 2017). Parents who report higher marital satisfaction and spousal support are less likely to experience parental burnout (Aktu, 2024;Cassé et al., 2016;Cheng et al., 2021;Sanders et al., 2014). Furthermore, emotional security theory suggests that the quality of the spousal relationship influences children's emotional security-defined as their sense of trust, stability, and confidence in their parents' ability to maintain family stability-which significantly impacts their psychological development (Davies & Cummings, 1994). ...
The spouse, parent-child, and sibling subsystems are critical components in the dynamics of multi-child families, collectively contributing to family differentiation and cohesion. This study employs a person-centered approach to explore the interdependence among these subsystems in Chinese multi-child families in Shandong Province. Additionally, it examines the relationships between subsystem patterns and two key outcomes: parental burnout and adolescent loneliness. Data were collected through a survey of 547 adolescent-parent pairs, all from intact, first-marriage, multi-child families. Using latent profile analysis based on marital, parent-child, and sibling relationships, the study identified three distinct profiles within multi-child families: Harmonious (73.1%), Disharmonious-Spillover (20.3%), and Disharmonious-Compensatory (6.6%). Results indicate that Harmonious families are associated with the lowest levels of parental burnout and adolescent loneliness. Conversely, Disharmonious-Spillover families exhibit the highest levels of adolescent loneliness, while Disharmonious-Compensatory families experience the highest levels of parental burnout.
... Some of these well-known programs include elements of observational learning (such as behavior modeling) include the Triple P Positive Learning Program (Triple P; Sanders, 2012), Parent Management Training -Oregon Model (Forgatch & Patterson, 2010), Parent Child Interaction Therapy (Fernandez & Eyberg, 2009), and the Incredible Years Program (Webster-Stratton, 1998). Most of these programs focus on positive parenting approaches, and Triple P has had widespread, effective results (Sanders et al., 2014). These results suggested that Triple P was effective for promoting short term, positive changes to children's functioning, parenting adjustment and satisfaction, and parent/family relationships. ...
Anxiety disorders often onset in adolescence and continue into adulthood. Multiple factors contribute to anxiety disorder development, such as parent emotional availability (EA) and adolescent anxiety sensitivity (AS). Previous research determined attachment is a similar construct to EA, and attachment is related to anxiety disorders. Moreover, EA is a more specific construct than attachment that can be targeted in therapy. It has been determined that adolescent attachment to parental figures contributes to anxiety, with AS mediating this relationship. The present research sought to determine if AS is one mechanism underlying the relationship between parent EA and adolescent anxiety, while exploring the moderating roles of parent and adolescent gender. In a Midwestern sample (13–19 years old), this study examined adolescent AS as a mediator of the relationship between perceived parent EA and adolescent anxiety, and gender as a potential moderator. Self-report data were collected from adolescents via Qualtrics. The findings supported the mechanism of adolescent AS as a mediator between perceived parent EA and adolescent anxiety. As AS emerges during adolescence, it is a pertinent treatment target for youth anxiety. Furthermore, this study underscores the significance of parent and adolescent gender and parental EA as treatment targets for adolescent anxiety. While targeting adolescent AS and enhancing parental EA can be beneficial for both male and female adolescents, focusing on parental EA may offer greater benefits for male adolescents. In sum, these findings can increase the efficacy of current parenting programs and further increase treatment outcomes for youth and families.
... Similarly, qualitative research involving novice and experienced healthcare professionals in cardiovascular settings suggests that experienced professionals are better at tailoring education to patients' specific needs and circumstances [29]. This patient-centered approach considers the patient's desire for information and shapes education from the patient's perspective [30,31], which can be the basis for improving educational practice. No significant differences were found between novice and experienced physiotherapists in their perception of the importance of most educational content. ...
Background: Patient education is a key aspect of physical therapy practice; however, the differences in how experienced and novice physiotherapists perceive and apply patient education practice remain underexplored. Understanding these differences influences training approaches and improves physical therapy practice quality. This research aims to determine the difference in self-reported patient education practice between experienced and novice physiotherapists. Methods: A previously published online survey instrument was used to collect data from physiotherapists employed in public health institutions in Bosnia and Herzegovina. The survey questions included demographic characteristics and questions about approaches to patient education, perceived importance, and factors contributing to skills development. Participants were recruited in two groups: experienced physiotherapists with work experience ≥ 11 years (n = 139) and novice physiotherapists with work experience ≤ 5 years (n = 45). Descriptive statistics, such as numbers and percentages, were used to summarize participant responses. Results: Experienced physiotherapists more frequently provided advice on posture, movement correction, daily activity strategies, and pacing while addressing patient concerns and exploring perceptions (p < 0.05). In contrast, novice physiotherapists placed significantly greater value on continuing education courses, considering them an important factor in developing patient education skills (p < 0.05). Conclusions: Experienced physiotherapists prioritize patient education focusing on posture, movement, and self-care strategies compared to novice physiotherapists. However, novice physiotherapists place a higher importance role on continuous education. Identifying these differences may help tailor training and mentorship to improve physiotherapy practice, ensuring better patient outcomes.
... The current meta-analysis supports the view that this would be a promising avenue for future studies. Hence, we advocate for broader programs with a dual focus on the parent-child relationship and the child's emotional well-being, such as the Positive Parenting Program (Triple P), which has been shown to be effective in promoting both healthy family interactions and child developmental outcomes (Sanders et al., 2014). ...
Empirical findings on the associations of positive and dysfunctional parent–child relationship (PPCR/DPCR) characteristics with child shame, adaptive guilt, and maladaptive guilt were synthesized in six meta-analyses. The 65 included samples yielded 633 effect sizes (Ntotal = 19,144; Mage = 15.24 years; 59.0% female; 67.7% U.S. samples, n = 12,036 with 65% White, 12.3% Hispanic and Latinx, 10.8% Black, 6.3% mixed race, 5.6% Asian American, 0.3% Native American participants). Small positive correlations were found between DPCR and shame (r = .17), DPCR and maladaptive guilt (r = .15), and PPCR and adaptive guilt (r = .14). A small negative correlation was found between PPCR and shame ( r = −.12). Sample and study moderators and sources of bias are investigated and discussed.
... Parents need to create one-on-one time, talk, or act in ways that build emotional connection like practicing calm breathing and positive self-talk as examples of emotion regulation, and encourage active listening so the child learns he/she can make decisions. As a result of these practices, Australia has reduced behavioral problems and strengthened family bonds, resulting in children with greater resilience to academic and life pressures [23]. Family members can ...
Today's children face unprecedented challenges due to the digital age, diverse family structures, and intense social and educational pressures, all of which contribute to mental health issues like anxiety, depression, and behavioral issues. The importance of fostering children's psychological resilience is widely acknowledged, but how the family atmosphere shapes this resilience remains largely unknown. In this study, the effects of supportive, conflictual, and neglectful family environments on children's resilience are examined. It has been shown that children's ability to cope with adversity is significantly enhanced when their families are characterized by warmth, communication, and stability. The converse has been true in environments characterized by conflict or neglect, where resilience is reduced and mental health problems are more likely to occur. In light of these findings, this paper makes recommendations aimed at strengthening the family climate, including promoting emotional support, implementing effective parenting practices, and encouraging cooperative rule-making. As well as mitigating current psychological challenges, these strategies are crucial for improving children's resilience and ensuring long-term mental health.
... Years and Triple P (Positive Parenting Program), aim to enhance parenting skills, improve parent-child interactions, and promote effective discipline strategies [18,19]. Such interventions have demonstrated positive impacts on child behavioral problems, emotion regulation, and overall family functioning. ...
Emotional regulation not only contributes to developmental change, but is itself a developmental process. Emotion regulation strategies, application, and effectiveness also vary across age groups. Interventions to improve emotion regulation must be tailored to the unique needs of children, adults, and older adults. Therefore, understanding its life cycle development is of utmost importance. However, to date, developmental studies have largely focused on specific life stages, and research across different age groups speaks little. This chapter aims to synthesize the available evidence from lifespan perspective moving from childhood through adolescence to adulthood and old age. It reviews key findings on how individuals at different developmental stages have specific needs and limitations related to emotion regulation, and how clinicians might use evidence-based therapy approaches to effectively address these diverse age groups. In childhood, emotion regulation skills are just emerging, and interventions should focus on building foundational abilities such as recognizing emotions and using simple strategies. For adults, interventions can target more complex regulation skills to manage intense emotions and maladaptive patterns. Older adulthood brings changes in cognition, physical health, and social context that require adapting emotion regulation approaches. By aligning interventions with age-related emotional and cognitive changes, clinical therapists can help individuals to adaptively manage their feelings across all stages of life.
... In the literature, interventions such as the Triple P (Positive Parenting Program) and Family Check-Up (FCU) have been noted for their ability to help families develop positive parenting skills and support their children's mental health (Sanders et al., 2014;Leijten et al., 2015;Berkel et al., 2021). The Triple P program is an evidence-based parent support system aimed at reducing social, emotional, and behavioral issues in children and adolescents. ...
ABSTRACT
Aim: This review aims to investigate the effectiveness of family-based approaches in preventing
psychiatric disorders in youth. It aims to evaluate the role of family intervention strategies in
preventing psychiatric disorders by examining the effects of family structure and dynamics on the
mental health of youth. Method: The study was conducted by systematically scanning the current
literature on family-based approaches and prevention of psychiatric disorders. Academic articles,
researches and case studies obtained from databases (PubMed, PsycINFO, Google Scholar) were
examined and the effectiveness of family-based strategies and application examples were
evaluated in detail. Findings: Family-based approaches play a critical role in preventing
psychiatric disorders in youth. Communication, support and education programs within the family
provide important effects in protecting and improving the mental health of youth. Strong ties and
supportive relationships among family members help youth cope with stress and psychological
difficulties. Family intervention strategies may be effective in reducing the likelihood of
developing psychiatric disorders, especially in at-risk youth. Family-based programs generally
include components such as parent education, family therapy, and psychoeducation. These
programs raise awareness among family members about psychiatric disorders and teach them how
to provide support in times of crisis. Research has shown that family-based intervention programs
have positive effects on the mental health of young people. Conclusions: Family-based approaches
stand out as an effective strategy in preventing psychiatric disorders in young people. Supportive
relationships and intervention programs within the family play an important role in protecting the
mental health of young people and preventing the development of psychiatric disorders. Familybased approaches increase the mental well-being of young people while also strengthening family
dynamics. In this context, community-based projects and education programs should be developed
to reach wider audiences with family-based programs and interventions. The dissemination and
effective implementation of parent education and family therapy programs can be encouraged.
Keywords: Family-based approaches, psychiatric disorders, prevention strategies,
psychotherapeutic interventions.
Maternal childrearing practices play a prominent role in a child’s developmental outcomes. Difficult child temperament, specifically, negative emotionality, impacts parenting practices. The present study contributes to the existing literature by investigating the mediating role of parenting practices on associations between children’s temperament and academic and behavioural outcomes in a low-income and ethnically diverse sample. The present study consists of a sample of 163 families. The average age of the children was 32.40 months (SD = 2.61 months). The average age of the mothers was 34.35 years (SD = 5.32 years). Structural equation modelling examined the relationship between children’s temperament, parenting practices, and child outcomes. A two-step procedure was conducted to test this model: confirmatory factor analysis followed by latent path analysis. The results show that children’s temperament was significantly and positively associated with mothers’ hostile parenting and children’s conduct problems. Hostile parenting was positively associated with children’s conduct problems. While overprotective parenting was negatively associated with children’s receptive vocabulary scores, maternal responsivity was positively associated with better receptive vocabulary in children. Finally, hostile parenting was found to play a significant and positive mediating role in children’s conduct behaviour. Maternal practices are associated with outcomes in children with negative emotionality, underscoring the need for tailored interventions in diverse, low-income families.
Uno de los criterios de calidad de los programas de intervención familiar es disponer de un manual con suficiente grado de sistematización que permita una implementación fiel a los componentes clave del programa, a su vez de forma lo suficientemente flexible como para garantizar su validez ecológica. Con objeto de avanzar en esta línea, en este trabajo se analizan los objetivos, la metodología y las áreas en las que se observan cambios del Programa de Tratamiento a Familias con Menores en Situación de Riesgo o Desprotección, a partir del análisis de contenido de 208 hojas de registro de seguimiento de sesiones cumplimentadas por 51 profesionales procedentes de 17 Equipos de Tratamiento Familiar. Los resultados mostraron que la evaluación inicial y el fomento de relaciones familiares fueron los objetivos trabajados más frecuentemente; las técnicas de evaluación y recogida de información aparecieron con mayor frecuencia; y las áreas en las que se detectan más cambios fueron las relaciones familiares y el ajuste infantil y adulto. La variabilidad en los resultados refleja la necesidad de sistematizar los objetivos, los mecanismos de cambio y las técnicas de intervención, para cumplir con los estándares de calidad de los Programas Basados en Evidencias.
Background
Women who have additional social and care needs in pregnancy (e.g. social adversity, maternal depression and anxiety) are likely to produce high levels of stress hormones. This has the potential to affect fetal brain development, increase infant reactivity to stress, and impair sensitive mother–infant bonds from developing. These in turn may have long-term effects on children’s health, social and educational outcomes. Parenting interventions show promising improvements to child outcomes; however, there is little evidence of their efficacy in the UK.
Objective(s)
THRIVE compared the impact of taking part in one of two antenatal parenting support programmes both incorporating cognitive–behavioural therapy (Enhanced Triple P for Baby or Mellow Bumps) with care-as-usual alone on the mental health and maternal attunement of vulnerable mothers-to-be, as well as the socioemotional and behavioural development of their children.
Design
THRIVE is a three-arm randomised controlled trial. Pregnant women with additional social and care needs in pregnancies were invited to participate. Participants were randomly allocated to Enhanced Triple P for Baby, Mellow Bumps or care-as-usual
Setting
The study took place in National Health Service Greater Glasgow and Clyde and National Health Service Ayrshire and Arran health board areas. Intervention sessions were predominantly in community settings.
Participants
Women identified as having additional social and care needs in pregnancies during pregnancy based on the National Health Service Greater Glasgow and Clyde’s Special Needs in Pregnancy criteria were recruited to THRIVE ( n = 485), slightly below the target of 500 women. Participants were block-randomised 5 : 5 : 2 to Enhanced Triple P for Baby, Mellow Bumps or care-as-usual. Subsequently their babies and accompanying person of choice were also invited.
Interventions
Enhanced Triple P for Baby consists of four weekly group-based antenatal sessions followed by up to three postnatal home visits and one postnatal group session. It aims to provide babies with a healthy start to life by combining parenting skills training with strategies to enhance individual well-being and couple adjustment. Mellow Bumps in comparison, comprises of seven weekly antenatal sessions and one postnatal session. It aims to decrease maternal stress, increase understanding of neonates’ capacity for social interaction, and emphasise the importance of early interaction for brain development and attachment. Recruitment to the trial took place between early 2014 and May 2018.
Main outcome measures
Our two primary outcomes were the Hospital Anxiety and Depression Scale, plus outwardly directed irritability from the Adult Wellbeing Scale, and CARE Index mother–infant dyadic interaction synchrony.
Results
There were no significant differences in the change from baseline in Hospital Anxiety and Depression Scale and outwardly expressed irritability score between the combined active intervention groups and care-as-usual only [effect size (95% confidence interval) 0.03 (−0.24 to 0.29)], or between either Enhanced Triple P for Baby and Care-as-usual only [0.04 (−0.24 to 0.32)] or Mellow Bumps and care-as-usual only [0.01 (−0.27 to 0.30)].
Mellow Bumps holds promise for cost-effectiveness due to its potential for cost-savings relating to routine healthcare resource use.
Limitations
The main limitation of THRIVE was poor attendance of the groups (under 42%) offered to our Enhanced Triple P for Baby and Mellow Bumps participants. However, subgroup analysis adjusted for level of attendance suggested the results would not have been any different with increased participation.
Conclusions
With the population THRIVE involved, at a stage of pregnancy when a lot of support is offered (with many parenting interventions being offered without rigorous evaluation), we do not have evidence to recommend the rollout of Enhanced Triple P for Baby or Mellow Bumps.
Future work
Future work could explore the timing and intensity of interventions, intervention group composition, co-produced programmes, online sessions, and impact of addressing inequalities.
Trial registration
This trial is registered as Current Controlled Trials ISRCTN21656568 (www.isrctn.com/ISRCTN21656568).
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref. 11/3002/01) and is published in full in Public Health Research ; Vol. 13, No. 4. See the NIHR Funding and Awards website for further award information.
This chapter provides an overview of models of change for behavioral and health disorders as applied to integrated pediatric primary care settings. It describes how Behavioral Health Consultants (BHCs) can employ these models to facilitate health behavior change in patients. The socioecological model is presented as an overarching framework for understanding the multiple levels of influence on health behaviors. Four additional models are discussed: the transtheoretical model, health belief model, theory of planned behavior, and social cognitive theory. This chapter explores how these models conceptualize behavior change processes and can guide interventions. Considerations specific to pediatric populations are highlighted, including the important role of caregivers. Two case vignettes demonstrate the practical applications of the health belief model for addressing child discipline and the transtheoretical model for improving dietary intake in adolescents. By considering multiple levels of influence and tailoring approaches accordingly, BHCs can develop targeted and effective strategies to facilitate behavioral change in pediatric patients and families.
Numerous studies have investigated the impacts of corporal punishment (CP) within families. However, there has been limited research on how these practices are transmitted across generations. This scoping review synthesized 18 peer-reviewed articles published between 2000 and 2023 from four databases, including PsycINFO, PubMed, PsycNet, and ProQuest. The findings revealed that 16 out of 18 studies showed a significant positive correlation in the intergenerational transmission of CP. Among them, nine studies indicated the intergenerational transmission of perpetrating CP, while seven found individuals with childhood CP experience would approve CP. Conversely, only one study suggested a negative association, indicating adults experienced childhood CP were less likely to use it on their own children. Additionally, one study found no significant impact of harsh mothering on later harsh parenting behaviors. These mixed findings highlight the intricate relationship between childhood CP experiences and adult disciplinary attitudes and behaviors. Future studies should prioritize longitudinal research and culturally sensitive approaches to better understand the mechanisms underlying CP transmission and develop effective strategies to break this cycle across generations.
Atferdsvansker, også kalt atferdsproblemer, hos barn og unge er vanskelig for det enkelte barn, familien og samfunnet for øvrig. Vi undersøkte virkningene av ulike tiltak for barn og unge med atferdsvansker eller som har begått kriminelle handlinger. Vi utførte en kunnskapsoppsummering over åtte systematiske oversikter. De ga resultater for 74 ulike tiltak for omtrent 50 000 barn og unge under 18 år.
Resultatene viser at det er sannsynlig at:
psykososiale tiltak som involverer foreldre gir en reduksjon i atferdsvansker hos barn
psykososiale multisystemiske tiltak (dvs. at innsatsene rettes mot flere sosiale systemer, f.eks. foreldre og barn) gir en reduksjon i atferdsvansker hos tenåringer
funksjonell familieterapi gir en reduksjon i atferdsvansker hos unge som har atferdsvansker og rusmisbruk
foreldreveiledning gir en reduksjon i atferdsvansker hos barn
familiebaserte tiltak gir en reduksjon i antisosial atferd, slik som lovbrudd, hos unge som har begått alvorlige lovbrudd
Også andre tiltak virker lovende, slik som funksjonell familieterapi når det gjelder forbygging av nye lovovertredelser hos unge. Men vi er noe usikre på virkningene av disse tiltakene.
For praksisfeltet og beslutningstakere er det viktig å merke seg den vedvarende positive virkningen av familiebaserte tiltak. Det gjelder særlig foreldreveiledning, slik at de gjennom å gjøre endringer i egen oppdragerpraksis kan veilede barna til endringer i atferd.
Aim: This study aimed to determine the effectiveness of positive parenting education and the social and emotional learning education of parents of preschool children on their children's adaptive behavior. Methods: The method of this study is quasi-experimental with a three-group pretest-posttest design of two study groups and a control group and a one-month follow-up. The statistical population of the study consisted of parents of preschool children with their children in Tehran in 2019. Accordingly, 45 mothers were selected by convenience sampling method and randomly divided into two study groups (15 people in each group) and one control group (15 people). One of the study groups received the Saunders Positive Parenting Education, 2005, and the other study group received the Kessel Social-Emotional Learning Education, 2003, for eight 90-minute sessions, and the control group was on the waiting list. The research tool included the Vineland Adaptive Behavior Scale (1965), which was assessed in three stages of pre-test, post-test, and follow-up. The repeated measures variance method was used to analyze the data. Results: The results indicated that the positive parenting intervention and socio-emotional learning are effective on individual independence (F = 18.19 and P = 0.001), social behavior (F = 4.69 and P = 0.010) and total score of adaptive marital behavior (F = 15.39 and P = 0.001). This result was stable at the follow-up stage. Conclusion: The findings revealed that both interventions employed in this study can significantly improve adaptive behavior in children. Therefore, these educational services can be used in preschool centers to improve adaptive behavior among children.
Early childhood adversity presents risks for enduring negative impacts on both health and development. Prior research has underscored the potential of early interventions to serve as a protective buffer, mitigating the detrimental effects of adversity on children. This study extends this research by investigating the impact of an early intervention, Attachment Biobehavioral Catch-up (ABC), on family functioning. Using latent transition analysis, this study’s findings indicate that families initially categorized as having lower functioning demonstrated a heightened likelihood of transitioning to a higher functioning profile on program completion, implying potential trajectories toward enhanced family functioning following participation in ABC. Although exploratory, these results suggest that ABC may provide supplementary protective effects that extend beyond enhancements in caregiver skills or improved child well-being.
This chapter summarises evidence-based therapies that have been reported as being effective in managing a wide range of issues that arise with vulnerable families. The chapter reviews evidence about the efficacy of therapies that can be targeted to address specific issues. One purpose of this chapter is to encourage policy makers to recognise the availability of evidence-based early intervention therapies for vulnerable families both while children remain in the care of their parents and after children have been placed in foster care. The second purpose of this chapter is to encourage mental health clinicians to upskill themselves about available therapies.
Translated and published article
Three variants of a behavioral family intervention (BFI) program known as Triple P were compared using 305 preschoolers at high risk of developing conduct problems. Families were randomly assigned to enhanced BFI (EBFI), standard BFI (SBFI), self-directed BFI (SDBFI), or wait list (WL). At postintervention, the 2 practitioner-assisted conditions were associated with lower levels of parent-reported disruptive child behavior, lower levels of dysfunctional parenting, greater parental competence, and higher consumer satisfaction than the SDBFI and WL conditions. Overall, children in EBFI showed greater reliable improvement than children in SBFI, SDBFI, and WL. By 1-year follow-up, children in all 3 conditions achieved similar levels of clinically reliable change in observed disruptive behavior. However, the EBFI and SBFI conditions showed greater reliable improvement on parent-observed disruptive child behavior.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Behavioural parent training programs have been developed to address child be-haviour problems through improvement in parenting practices. Ideally, programswould demonstrate effectiveness with all parents. The Triple P-Positive ParentingProgram is widely reported as an effective, evidence-based program for parents. However, in this meta-analysis we demonstrate that there are significant differencesin program effectiveness for mothers and fathers. We show that while Triple P hasa large positive effect on mothers’ parenting practices, it has a smaller effect on fa-thers’ parenting practices. Considering that fathers make a significant and uniquecontribution to child development, we argue that it is important for parenting pro-grams to assess their effectiveness with fathers as well as mothers.
To provide an analytical framework within which public health interventions can be evaluated, present its mathematical proof, and demonstrate its use using real trial data.
This article describes a method to assess population-level effects by describing change using the distribution curve. The area between the two overlapping distribution curves at baseline and follow-up represents the impact of the intervention, that is, the proportion of the target population that benefited from the intervention.
Using trial data from a parenting program, empirical proof of the idea is demonstrated on a measure of behavioral problems in 355 preschoolers using the Gaussian distribution curve. The intervention group had a 12% [9%-17%] health gain, whereas the control group had 3% [1%-7%]. In addition, for the subgroup of parents with lower education, the intervention produced a 15% [6%-25%] improvement, whereas for the group of parents with higher education the net health gain was 6% [4%-16%].
It is possible to calculate the impact of public health interventions by using the distribution curve of a variable, which requires knowing the distribution function. The method can be used to assess the differential impact of population interventions and their potential to improve health inequities.
A noninferiority randomized trial design compared the efficacy of two self-help variants of the Triple P-Positive Parenting Program: an online version and a self-help workbook. We randomly assigned families of 193 children displaying early onset disruptive behavior difficulties to the online (N = 97) or workbook (N = 96) interventions. Parents completed questionnaire measures of child behavior, parenting, child maltreatment risk, personal adjustment and relationship quality at pre- and post-intervention and again at 6-month follow up. The short-term intervention effects of the Triple P Online program were not inferior to the workbook on the primary outcomes of disruptive child behavior and dysfunctional parenting as reported by both mothers and fathers. Both interventions were associated with significant and clinically meaningful declines from pre- to post-intervention in levels of disruptive child behavior, dysfunctional parenting styles, risk of child maltreatment, and inter-parental conflict on both mother and father report measures. Intervention effects were largely maintained at 6-month follow up, thus supporting the use of self-help parenting programs within a comprehensive population-based system of parenting support to reduce child maltreatment and behavioral problems in children.
This study presents the standardization data for a brief behavioral inventory of child conduct problem behaviors. The 36 item Eyberg Child Behavior Inventory (ECBI) was completed by the parents of 512 children (56% boys) ages 2 to 12. The psychometric characteristics of ECBI indicated that it is a reliable (.86 to .98) and valid instrument whose normally distributed scale is sensitive to a broad range of behavioral variability on the conduct problem dimension. Boys were reported to evidence more conduct problems than girls (p < .001; and mothers consistently reported more problem behaviors than fathers (p < .001). The relative consistency of ECBI scores across ages suggested that a conduct disorder is independent of stages in the child's development. It was suggested that conduct problem behavior is a manifestation of the interaction between the parent and child. The ECBI provides a psycho‐metrically sound parent‐report instrument to be used as an adjunct to observational methods in the treatment and study of conduct problem behaviors.
The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility—the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Muñoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.
Background:
Interventions to promote positive parenting are often reported to offer good outcomes for children but they can consume substantial resources and they require rigorous appraisal.
Methods:
Evaluations of the Triple P parenting program were subjected to systematic review and meta-analysis with analysis of biases. PsychInfo, Embase and Ovid Medline were used as data sources. We selected published articles reporting any child-based outcome in which any variant of Triple P was evaluated in relation to a comparison condition. Unpublished data, papers in languages other than English and some book chapters were not examined. Studies reporting Eyberg Child Behavior Inventory or Child Behavior Checklist scores as outcomes were used in the meta-analysis.
Results:
A total of 33 eligible studies was identified, most involving media-recruited families. Thirty-one of these 33 studies compared Triple P interventions with waiting list or no-treatment comparison groups. Most papers only reported maternal assessments of child behavior. Twenty-three papers were incorporated in the meta-analysis. No studies involved children younger than two-years old and comparisons of intervention and control groups beyond the duration of the intervention were only possible in five studies. For maternally-reported outcomes the summary effect size was 0.61 (95%CI 0.42, 0.79). Paternally-reported outcomes following Triple P intervention were smaller and did not differ significantly from the control condition (effect size 0.42 (95%CI -0.02, 0.87)). The two studies involving an active control group showed no between-group differences. There was limited evidence of publication bias, but there was substantial selective reporting bias, and preferential reporting of positive results in article abstracts. Thirty-two of the 33 eligible studies were authored by Triple-P affiliated personnel. No trials were registered and only two papers contained conflict of interest statements.
Conclusions:
In volunteer populations over the short term, mothers generally report that Triple P group interventions are better than no intervention, but there is concern about these results given the high risk of bias, poor reporting and potential conflicts of interest. We found no convincing evidence that Triple P interventions work across the whole population or that any benefits are long-term. Given the substantial cost implications, commissioners should apply to parenting programs the standards used in assessing pharmaceutical interventions. See related commentary: http://www.biomedcentral.com/1741-7015/10/145.
The authors propose that meta-analysts explicitly specify their research question and their standards for adequate studies to be included, using whatever standards they would have applied had they been asked to peer-review the individual studies for funding. Such a proposal corresponds to previous ones with regard to considerations of sampling, measurement, design, and analysis adequacy, but the authors of this study extend the proposal to the inclusion of the definition of adequate power. They show that if adequate power is defined and then used in reviewing studies for inclusion in a meta-analysis, excluding those that are by the meta-analysts' own criterion "underpowered," this strategy would go far toward removing bias due to the "file-drawer problem" and resulting misleading research conclusions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
If therapists know why couples seek marital therapy, they can more effectively tailor their therapies to improve treatment outcome. Unfortunately, there have been no systematic studies to date on couples' reasons for seeking therapy. In a survey of 147 married couples seeking marital therapy, the most commonly reported reasons were problematic communication and lack of emotional affection. Within individual couples, spouses showed little agreement on their reasons for therapy, suggesting that careful and individual assessments should be made of each spouse. There was only partial overlap of couples' reasons for seeking therapy, questionnaires of relationship problems, and previous studies of therapists' reports of couples' problems, indicating that traditional methods of assessment may not fully capture why couples are seeking therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article examines whether differences in the equations commonly used to calculate effect size for single group pretest-posttest (SGPP) designs versus those for control group designs can account for the finding that SGPP designs yield larger mean effect sizes (e.g., M. S. Lipsey & D. B. Wilson, 1993). It was found that the assumptions of no control group effect and the equivalence of pretraining and posttraining dependent variable standard deviations required for these equations to produce equivalent estimates of effect size were violated for some dependent variable types. Results indicate that control group effects and inflation in the standard deviation of the posttraining dependent variable measure account for most of the observed difference in effect size. The most severe violations occurred when the dependent variable was a knowledge assessment. Methods for including data from SGPP designs in meta-analyses that minimize potential biases are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Harsh parenting practices and negative parental feelings may be environmental risk factors for low self-control in children. Children may also evoke certain parenting reactions.
To investigate the longitudinal relationship between parenting and self-control, as well as associated outcomes within the monozygotic (MZ) twin differences framework.
Longitudinal MZ twin differences analysis was conducted on a community sample of 5184 twins using data from ages 3, 4, 7 and 9 years. Outcomes related to self-control and parenting were analysed at age 12 years.
Non-shared environmental effects of parenting on the development of self-control and an evocative effect of child self-control on parenting were found. Harsh parenting predicted conduct problems for both boys and girls. Self-control at age 9 predicted conduct problems and emotional difficulties at age 12.
Parenting and child self-control affect one another, highlighting the potential of early interventions that target parents and children simultaneously.
Triple P is a parenting program intended to prevent and to provide treatment for severe behavioral, emotional, and developmental problems in children. The aim of this meta-analysis was to assess the effectiveness of Triple P Level 4 interventions on parenting styles and parental competency. Level 4 is an intensive training program of 8 – 10 sessions for parents of children with more severe behavioral difficulties. The results indicated that the Triple P Level 4 interventions reduced dysfunctional parenting styles in parents and also improved parental competency. These effects were maintained well through time and appear to support the widespread adoption and implementation of Triple P Level 4 interventions that is taking place in an increasing number of countries around the world.
Current findings on parental influences provide more sophisticated and less deterministic explanations than did earlier theory and research on parenting. Contemporary research approaches include (a) behavior-genetic designs, augmented with direct measures of potential environmental influences; (b) studies distinguishing among children with different genetically influenced predispositions in terms of their responses to different environmental conditions; (c) experimental and quasi-experimental studies of change in children's behavior as a result of their exposure to parents' behavior, after controlling for children's initial characteristics; and (d) research on interactions between parenting and nonfamilial environmental influences and contexts, illustrating contemporary concern with influences beyond the parent-child dyad. These approaches indicate that parental influences on child development are neither as unambiguous as earlier researchers suggested nor as insubstantial as current critics claim.
Much of the literature on meta-analysis deals with analyzing effect sizes obtained from k independent studies in each of which a single treatment is compared with a control (or with a standard treatment). Because the studies are statistically independent, so are the effect sizes. Studies, however, are not always so simple. For example, some may compare multiple variants of a type of treatment against a common control. Thus, in a study of the beneficial effects of exercise on blood pressure, independent groups of subjects may each be assigned one of several types of exercise: running for twenty minutes daily, running for forty minutes daily, running every other day, brisk walking, and so on. Each of these exercise groups is to be compared with a common sedentary control group. In consequence, such a study will yield more than one exercise versus control effect size. Because the effect sizes share a common control group, the estimates of these effect sizes will be correlated. Studies of this kind are called multiple-treatment studies. In other studies, the single-treatment, single-control paradigm may be followed, but multiple measures will be used as endpoints for each subject. Thus, in comparing exercise and lack of exercise on subjects' health, measurements of systolic blood pressure, diastolic blood pressure, pulse rate, cholesterol concentration, and so on, may be taken for each subject. Similarly, studies of the use of carbon dioxide for storage of apples can include measures of flavor, appearance, firmness, and resistance to disease. A treatment versus control effect-size estimate may be calculated for each endpoint measure. Because measures on a common subject are likely to be correlated, corresponding estimated effect sizes for these measures will be correlated within studies. Studies of this type are called multiple-endpoint studies (for further discussions of multiple-endpoint studies, see Gleser and Olkin 1994; Raudenbush, Becker, and Kalaian 1988; Timm 1999). A special, but common, kind of multiple-endpoint study is that in which the measures (endpoints) used are sub-scales of a psychological test. For study-to-study comparisons, or to have a single effect size for treatment versus control, we may want to combine the effect sizes obtained from the subscales into an overall effect size. Because subscales have differing accuracies, it is well known that weighted averages of such effect sizes are required. Weighting by inverses of the variances of the estimated subscale effect sizes is appropriate when these effect sizes are independent, but may not produce the most precise estimates when the effect sizes are correlated. In each of these above situations, possible dependency among the estimated effect sizes needs to be accounted for in the analysis. To do so, additional information has to be obtained from the various studies. For example, in the multiple-endpoint studies, dependence among the end-point measures leads to dependence between the corresponding estimated effect sizes, and values for between-measures correlations will thus be needed for any analysis. Fortunately, as will be seen, in most cases this is all the extra information that will be needed. When the studies themselves fail to provide this information, the correlations can often be imputed from test manuals (when the measures are subscales of a test, for example) or from published literature on the measures used. When dealing with dependent estimated effect sizes, we need formulas for the covariances or correlations. Note that the dependency between estimated effect sizes in multiple-endpoint studies is intrinsic to such studies, arising from the relationships between the measures used, whereas the dependency between estimated effect sizes in multiple-treatment studies is an artifact of the design (the use of a common control). Consequently, formulas for the covariances between estimated effect sizes differ between the two types of studies, necessitating separate treatment of each type. On the other hand, the variances of the estimated effect sizes have the same form in both types of study - namely, that obtained from considering each effect size in isolation (see chapters 15 and 16, this volume). Recall that such variances depend on the true effect size, the sample sizes for treatment and control, and (possibly) the treatment-to-control variance ratio (when the variance of a given measurement is assumed to be affected by the treatment). As is often the case in analyses in other chapters in this volume, the results obtained are large sample (within studies) normality approximations based on use of the central limit theorem.
The goal of a public health approach to improving parenting is to increase the prevalence of effective parenting practices in a population. Achieving this goal requires that a large proportion of the population be reached with a spectrum of effective parenting supports, widely accessible in the community, and delivered in a variety of formats, through a variety of settings, and at different levels of intensity. Similarly, measuring the effectiveness of such a public health approach to improving parenting requires a spectrum of measurement tools at multiple levels so that child and family outcomes can be assessed at multiple levels of intervention. The levels of measurement include: (1) micro-focused observational measures, (2) easy-to-administer parent survey measures, (3) population-level prevalence indicators, and (4) program implementation measures. This chapter discusses these four levels of measurement, providing examples of each and exploring the contribution that each makes to a public health strategy.
Multivariate meta-analysis has become increasingly popular in the educational, social, and medical sciences. It is because the outcome measures in a meta-analysis can involve more than one effect size. This article proposes 2 mathematically equivalent models to implement multivariate meta-analysis in structural equation modeling (SEM). Specifically, this article shows how multivariate fixed-, random- and mixed-effects meta-analyses can be formulated as structural equation models. metaSEM (a free R package based on OpenMx) and Mplus are used to implement the proposed procedures. A real data set is used to illustrate the procedures. Formulating multivariate meta-analysis as structural equation models provides many new research opportunities for methodological development in both meta-analysis and SEM. Issues related to and extensions on the SEM-based meta-analysis are discussed.
IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
Randomized controlled trials and meta-analyses have demonstrated the efficacy of evidence-based parenting programs (EBPPs) to improve social, emotional, and behavioral outcomes for children. Although EBPPs are effective, their reach is limited, and many families that could benefit do not have an opportunity to participate. In this article, we argue for a paradigm shift—from traditional, highly targeted approaches of program delivery to a more inclusive public-health framework that blends universal and targeted elements. The Triple P—Positive Parenting Program is an EBPP that has applied a public-health framework to increase parenting support in communities. The approach seeks to improve the reach of the program while increasing capacity to reduce the prevalence of children's social, emotional, and behavioral problems, as well as of child maltreatment.
Most meta-analyses in marketing contain studies which themselves contain multiple measurements of the focal effect. This paper compares alternative procedures to deal with multiple measurements through the analysis of synthetic data sets in a Monte Carlo study and a re-analysis of a published marketing data set. We show that the choice of procedure to deal with multiple measurements is by no means trivial and that it has implications for the results and for the validity of the generalizations derived from meta-analyses. Procedures that use the complete set of measurements outperform procedures that represent each study by a single value. The commonly used method of treating all measurements as independent performs reasonably well but is not preferable. We show that the optimal procedure to account for multiple measurements in meta-analysis explicitly deals with the nested error structure, i.e., at the measurement level and at the study level, which has not been practiced before in marketing meta-analyses.
This study examined the effects of a family intervention on victimization and emotional distress of children bullied by peers. The intervention, Resilience Triple P, combined facilitative parenting and teaching children social and emotional skills relevant to developing strong peer relationships and addressing problems with peers. Facilitative parenting is parenting which supports the development of children’s peer relationship skills. A randomized controlled trial was conducted with 111 families who reported chronic bullying of children aged six to 12 years. Families were randomly allocated to either an immediate start to Resilience Triple P (RTP) or an assessment control (AC) condition. Assessments involving children, parents, teachers and observational measures were conducted at 0 (pre), 3 (post) and 9 months follow-up. RTP families had significantly greater improvements than AC families on measures of victimization, child distress, child peer and family relationships, including teacher reports of overt victimization (d = 0.56), child internalizing feelings (d = 0.59), depressive symptoms (d = 0.56), child overt aggression towards peers (d = 0.51), acceptance by same sex and opposite sex peers (d = 0.46/ 0.60), and child liking school (d = 0.65). Families in both conditions showed significant improvements on most variables over time including child reports of bullying in the last week reducing to a near zero and indistinguishable from the normative sample. The intervention combining facilitative parenting and social and emotional skills training for children produced better results than the comparison assessment control condition. This study demonstrated that family interventions can reduce victimization and distress and strengthen school efforts to address bullying.
Parenting interventions have the potential to make a significant impact to the prevention and treatment of major social and mental health problems of children. However, parenting interventions fail to do so because program developers pay insufficient attention to the broader ecological context that influences the adoption and implementation of evidence-based interventions. This context includes the professional and scientific community, end users, consumers, and broader sociopolitical environment within which parenting services are delivered. This paper presents an iterative stage model of quality assurance steps to guide ongoing research and development particularly those related to program innovations including theory building, intervention development, pilot testing, efficacy and effectiveness trials, program refinement, dissemination, and planning for implementation and political advocacy. The key challenges associated with each phase of the research and development process are identified. Stronger consumer participation throughout the entire process from initial program design to wider community dissemination is an important, but an often ignored part of the process. Specific quality assurance mechanisms are discussed that increase accountability, professional, and consumer confidence in an intervention and the evidence supporting its efficacy.
Francis (2012a, 2012b, 2012c, 2012d, 2012e, in press) attacks individual papers through critiques that apply faulty logic to analyses ironically biased by cherry picking. However well intentioned, the critiques are probably counterproductive to their stipulated goal and certainly unfair to the targeted authors.
© The Author(s) 2012.
Publication bias remains a controversial issue in psychological science. The tendency of psychological science to avoid publishing null results produces a situation that limits the replicability assumption of science, as replication cannot be meaningful without the potential acknowledgment of failed replications. We argue that the field often constructs arguments to block the publication and interpretation of null results and that null results may be further extinguished through questionable researcher practices. Given that science is dependent on the process of falsification, we argue that these problems reduce psychological science's capability to have a proper mechanism for theory falsification, thus resulting in the promulgation of numerous "undead" theories that are ideologically popular but have little basis in fact.
© The Author(s) 2012.
Psychological interventions to treat mental health issues have developed remarkably in the past few decades. Yet this progress often neglects a central goal-namely, to reduce the burden of mental illness and related conditions. The need for psychological services is enormous, and only a small proportion of individuals in need actually receive treatment. Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need. Despite advances, mental health professionals are not likely to reduce the prevalence, incidence, and burden of mental illness without a major shift in intervention research and clinical practice. A portfolio of models of delivery will be needed. We illustrate various models of delivery to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media. Decreasing the burden of mental illness also will depend on integrating prevention and treatment, developing assessment and a national database for monitoring mental illness and its burdens, considering contextual issues that influence delivery of treatment, and addressing potential tensions within the mental health professions. Finally, opportunities for multidisciplinary collaborations are discussed as key considerations for reducing the burden of mental illness.
© The Author(s) 2011.
Bias is a form of systematic error that can affect scientific investigations and distort the measurement process. A biased study loses validity in relation to the degree of the bias. While some study designs are more prone to bias, its presence is universal. It is difficult or even impossible to completely eliminate bias. In the process of attempting to do so, new bias may be introduced or a study may be rendered less generalizable. Therefore, the goals are to minimize bias and for both investigators and readers to comprehend its residual effects, limiting misinterpretation and misuse of data. Numerous forms of bias have been described, and the terminology can be confusing, overlapping, and specific to a medical specialty. Much of the terminology is drawn from the epidemiology literature and may not be common parlance for radiologists. In this review, various types of bias are discussed, with emphasis on the radiology literature, and common study designs in which bias occurs are presented.
The present meta-analytic review examined effectiveness of the Incredible Years parent training (IYPT) regarding disruptive and prosocial child behavior, and aimed to explain variability in intervention outcomes. Fifty studies, in which an intervention group receiving the IYPT was compared to a comparison group immediately after intervention, were included in the analyses. Results showed that the IYPT is an effective intervention. Positive effects for distinct outcomes and distinct informants were found, including a mean effect size of d=.27 concerning disruptive child behavior across informants. For parental report, treatment studies were associated with larger effects (d=.50) than indicated (d=.20) and selective (d=.13) prevention studies. Furthermore, initial severity of child behavior revealed to be the strongest predictor of intervention effects, with larger effects for studies including more severe cases. Findings indicate that the IYPT is successful in improving child behavior in a diverse range of families, and that the parent program may be considered well-established.
Rosenthan's (1979) concept of fail-safeN has thus far been applied to probability levels exclusively. This note introduces a fail-safeN for effect size.
Previous research has recommended several measures of effect size for studies with repeated measurements in both treatment and control groups. Three alternate effect size estimates were compared in terms of bias, precision, and robustness to heterogeneity of variance. The results favored an effect size based on the mean pre-post change in the treatment group minus the mean pre-post change in the control group, divided by the pooled pretest standard deviation.
Objectives:
To develop and validate a new risk-of-bias tool for nonrandomized studies (NRSs).
Study design and setting:
We developed the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). A validation process with 39 NRSs examined the reliability (interrater agreement), validity (the degree of correlation between the overall assessments of RoBANS and Methodological Index for Nonrandomized Studies [MINORS], obtained by plotting the overall risk of bias relative to effect size and funding source), face validity with eight experts, and completion time for the RoBANS approach.
Results:
RoBANS contains six domains: the selection of participants, confounding variables, the measurement of exposure, the blinding of the outcome assessments, incomplete outcome data, and selective outcome reporting. The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial. There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS. The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies. The mean time required to complete RoBANS was approximately 10 min. The external experts who were interviewed evaluated RoBANS as a "fair" assessment tool.
Conclusions:
RoBANS shows moderate reliability, promising feasibility, and validity. The further refinement of this tool and larger validation studies are required.
The study examined the effectiveness of Group Triple P, a Level 4 variant of the Triple P multilevel system of parenting support, with Chinese parents who had a preschool aged child with a developmental disability, using randomized controlled trial design. Participants (Intervention group: 42; Waitlist Control group: 39) completed measures on child behaviour, parental stress, dysfunctional discipline styles and parental conflict before and after program completion by the Intervention group. Intervention group participants also completed these same measures six months after program completion. Compared to the Waitlist Control group, parents receiving Group Triple P reported significantly lower levels of child behaviour problems, parental stress, dysfunctional discipline style and parental conflict scores. The Intervention group participants maintained their gains six months after program completion. The results provided promising evidence for the Level 4 Group Triple P as an effective intervention program for Chinese parents who have preschool aged children with developmental disabilities.
If science were a game, a dominant rule would probably be to collect results that are statistically significant. Several reviews of the psychological literature have shown that around 96% of papers involving the use of null hypothesis significance testing report significant outcomes for their main results but that the typical studies are insufficiently powerful for such a track record. We explain this paradox by showing that the use of several small underpowered samples often represents a more efficient research strategy (in terms of finding p < .05) than does the use of one larger (more powerful) sample. Publication bias and the most efficient strategy lead to inflated effects and high rates of false positives, especially when researchers also resorted to questionable research practices, such as adding participants after intermediate testing. We provide simulations that highlight the severity of such biases in meta-analyses. We consider 13 meta-analyses covering 281 primary studies in various fields of psychology and find indications of biases and/or an excess of significant results in seven. These results highlight the need for sufficiently powerful replications and changes in journal policies.
© The Author(s) 2012.
Presents an approach for the meta-analysis of data from pretest–posttest designs. With this approach, data from studies using different designs may be compared directly and studies without control groups do not need to be omitted. The approach is based on a standardized mean-change measure, computed for each sample within a study, and it involves analysis of the standardized mean changes and differences in the standardized mean changes. Analyses are illustrated using results of studies of the effectiveness of mental practice on motor-skill development (e.g., D. Feltz and D. M. Landers [see PA, Vol 71:325]). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Principal tasks of the early childhood years, including attaining self-efficacy, self-control, social integration, and preparedness for education, require the development of adaptive and competent emotional development. Results from longitudinal and intergenerational studies examining the effect of parenting behaviors on children's emotional outcomes provide support for the importance of parenting style as a mechanism in the development of competent or problematic emotional functioning over time and across generations. Despite the critical role of emotional competence on lifelong development, little longitudinal research has assessed its effect on children's cognitive, social, behavioral, and academic competence over time, or how parenting affects the emotional functioning and later developmental outcomes in subsequent generations. The objectives of the present article were to (1) summarize and integrate longitudinal and intergenerational research on the emotional development of at-risk and typically developing children; (2) evaluate research examining the role that parenting behaviors play in the development of children's emotional competence; (3) highlight cross-sectional research investigating parental influences on the emotional development of children with disabilities; and (4) describe how adaptive and maladaptive emotional development affect the overall functioning of children with and without developmental disabilities. The importance of studying emotional development is underscored, as well as implications for social, educational, and health policy.
We report a graded relationship between neighborhood socioeconomic status (SES) and children's antisocial behavior that (a) can be observed at school entry, (b) widens across childhood, (c) remains after controlling for family-level SES and risk, and (d) is completely mediated by maternal warmth and parental monitoring (defined throughout as supportive parenting). The children were participants in the Environmental Risk Longitudinal Twin Study (N = 2,232), which prospectively tracked the development of children and their neighborhoods across childhood. Direct and independent effects of neighborhood-level SES on children's antisocial behavior were observed as early as age 5, and the gap between children living in deprived versus more affluent neighborhoods widened as children approached adolescence. By age 12, the effect of neighborhood SES on children's antisocial behavior was as large as the effect observed for our most robust predictor of antisocial behavior: sex (Cohen d = 0.51 when comparing children growing up in deprived vs. more affluent neighborhoods in comparison to Cohen d = 0.53 when comparing antisocial behavior among boys vs. girls). However, these relatively large differences in children's levels and rate of change in antisocial behavior across deprived versus more affluent neighborhoods were completely mediated by supportive parenting practices. The implications of our findings for studying and reducing socioeconomic disparities in antisocial behavior among children are discussed.
Offering pragmatic guidance for planning and conducting a meta-analytic review, this book is written in an engaging, nontechnical style that makes it ideal for ...