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The Triple P-Positive Parenting Program: A Systematic Review and Meta-Analysis of a Multi-Level System of Parenting Support
... For example, in early childhood, EBPSs are the most efficacious interventions for emotional and behavioural problems and this has been demonstrated across diverse cultural and service contexts and populations [13][14][15][16]. EBPSs also are effective at changing parenting behaviours [15,[17][18][19][20][21][22]] and reducing child maltreatment risk [23][24][25], which addresses key environmental risk factors. Despite positive benefits to children and families [26], the access and reach of EBPSs varies across communities and remains limited in both low-and middle-income countries (LMICs) and high-income countries (HICs) [27]. ...
... employing the principle of proportionate universalism [28]). Population-level reach of EBPSs can be achieved by offering multiple levels of support, from light touch to more intensive, that relate to what the parent or caregiver is seeking and has the capacity to engage with [17]. A population-level approach to providing EBPSs also means there is not a one-size-fits-all or one single pathway into receiving an evidence-based parenting program. ...
... This population-based approach to implementation of EBPSs can be applicable to both HICs and LMICs. The evidence shows that EBPSs can be effectively transported into a variety of countries; which includes settings in which the EBPSs were not initially designed, in low-resource contexts, as well as settings with high violence rates [16,17,54,89,95,96]. The delivery of EBPSs needs to be flexible, with support being offered in traditional in-person services, as well as utilising telehealth and online delivery. ...
Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the
effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
... Prior reviews have concluded that group interventions contribute to significant improvements in both children's mental health and parents' psychological adjustment [11][12][13]. As one of the most widely delivered and studied interventions within the Triple P system [14], GTP requires practitioners/professionals to be trained and accredited, targeting audiences at a selective, preventive, or universal level. GTP can also precede a level 5 intervention in the case of highly stressed families. ...
... Nowak and Heinrichs [19] conducted a Triple P meta-analysis to identify moderator variables for program effectiveness and concluded that better results were associated with a more intensive format, particularly for the families revealing higher levels of distress before the intervention. The systematic review and meta-analysis of multi-level Triple P interventions led by Sanders and colleagues [14] included self-report and observational data and identified significant improvements at short (i.e., immediately after the intervention) and at longer-term (i.e., six and 12-months after the intervention) on children's behavior problems, parenting practices and sense of competence, parental adjustment and parental relationship. Despite these positive findings, a few concerns remain regarding the generalization and maintenance of the effects of the interventions and the quality of the research conducted. ...
... Wilson and colleagues [20] mention the possibility of selective reporting bias and potential conflicts of interest and conclude that there is no compelling evidence on the effects of Triple P interventions for the whole population or on the maintenance of benefits over time. Sanders and colleagues [14] also identified high or unclear levels of risk of bias in the studies they reviewed. The integrity of the intervention, that is, the degree to which an intervention is delivered as intended, remains an important factor to consider, as it has been associated with better outcomes in the parenting intervention literature [21,22]. ...
Supporting parents through the delivery of evidence-based parenting interventions (EBPI) is a way of promoting children’s rights, given the known benefits to child development and family wellbeing. Group Triple P (GTP) is an EBPI suitable for parents of children aged 2–12 years, who experience parenting difficulties, and/or child behavior problems. Even though GTP has been intensively studied, information lacks on the magnitude of its effects, considering the risk of bias within and across prior research. To address this, a systematic review and meta-analysis (PROSPERO registration CRD42019085360) to evaluate the effects of GTP on child and parent outcomes at short- and longer-term was performed. Through a systematic search of a set of databases, 737 research papers were identified, and 11 trials were selected. The risk of bias within and across studies was evaluated. Significant positive effects of GTP were found immediately after the intervention for child behavior problems, dysfunctional parenting practices, parenting sense of competence, psychological adjustment, parental stress levels, conflict, and relationship quality. Six months after the intervention, positive effects were found only for child behavior problems. Data suggest that GTP might be an effective EBPI leading to positive family outcomes. Substantial risk of bias was found, highlighting the importance of improving the quality of research.
... Improved parenting responsiveness resulted in better health and development in younger children, especially in poor settings. 41 48 Physical activity interventions showed improvements in motor skills and cognitive development in children aged <6 years. 36 After-school programs promoted positive behaviors, including self-care (SMD 5 0.503; 95% CI: 0.097 to 0.910) and reduced negative behaviors. ...
... First, a common recommendation across several domains is to implement multicomponent and multilevel interventions. 41,48,78,90,112,158 Several reviews suggest adding school-based components to comprehensive antibullying interventions 78,90 and integrating home-level responsive parenting interventions into child survival programs. 41,48 Furthermore, groups involved in intervention implementation, such as school health personnel, should be involved in intervention development and supported during implementation. ...
... 41,48,78,90,112,158 Several reviews suggest adding school-based components to comprehensive antibullying interventions 78,90 and integrating home-level responsive parenting interventions into child survival programs. 41,48 Furthermore, groups involved in intervention implementation, such as school health personnel, should be involved in intervention development and supported during implementation. 78 Several reviews also recommend training these groups for effective intervention programming. ...
CONTEXT
Previous reviews of mental health interventions have focused on adolescents (10–19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5–10 years).
OBJECTIVE
To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5–14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies.
DATA SOURCES
This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020.
STUDY SELECTION
We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5–14.9 years.
DATA EXTRACTION
Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality.
RESULTS
We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs.
LIMITATIONS
The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity.
CONCLUSIONS
This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.
... One widely used parenting intervention is the Triple P-Positive Parenting Program (23,24). Based on social learning theory and cognitive behavioral principles, it aims to improve confidence in the parenting role and modify maladaptive parenting behaviors (25). The self-directed variant also targets coercive family interactions and offers skill acquisition and problem solving (26,27). ...
... At completion, all participants were no longer meeting criteria for 'clinical' categories on outcome measures. Similarly, improvements across facets of child disruptive behaviors, positive parenting practices and parental self-efficacy was comparable to previous research (21,25,28,31). Participants moved from the "clinical" category showing fewer child behavior problems and less parental distress on the ECBI and were within the "normal" range for parenting practices on the PS. ...
Although many people with psychosis are parents, managing the dual demands of poor mental health and parenting can be stressful and may contribute to poorer outcomes for both parent and child. Parenting interventions have the potential to improve outcomes for the whole family but need evaluation of feasibility in this context. The Triple-P Self-Help Workbook was implemented with guidance and support with 10 parents experiencing psychosis in a multiple baseline case series study. Sessions were weekly and home-based. Outcome measures examined facets of parenting, child behavior, self-efficacy and parental mental health. Follow up interviews explored parents' perspectives of the perceived impact of the intervention and apparent mechanisms of change. The program resulted in clinically significant change (>25% improvement) in mental health, parenting and child behavior measures post-intervention for the 50% who completed all 10 sessions and improvements were maintained at 3 and 6 month follow up. Interviews with those who completed the program revealed it to have been transformative: parents reported positive changes in parenting style; they were empowered with regard to their parenting and had a greater sense of control over their mental health. This study provides preliminary evidence that self-directed Triple P might be able to reduce the symptoms of psychosis by improving family functioning. Findings could inform the future development or adaptation of evidence-based parenting interventions for parents with psychosis in order to improve their mental health, aid recovery, and intervene early in the lives of children at risk of poor long-term outcomes.
... EBPPs can prevent and reduce a wide range of child and adolescent problem behaviors by empowering parents with effective tools to promote positive parenting practices and hence reduce coercive family processes (Feinberg, 2020;Forgatch & Gewirtz, 2017). Recent systematic reviews and meta-analyses have demonstrated how individual evidencebased parenting programs, such as Triple P (Sanders et al., 2014) and incredible years (Leijten et al., 2018), improve aspects of parenting and child outcomes. However, no prior meta-analysis has systematically examined the impact of GenerationPMTO on parenting and child adjustment outcomes across studies. ...
... It is noteworthy that studies have found that parenting treatment interventions showed larger effect sizes compared to indicated and selective prevention studies for children's disruptive and prosocial behaviors, and initial child problem severity was a significant moderator for effect sizes (Menting et al., 2013;Sanders et al., 2014). The difference between effect sizes for treatment vs. prevention is not surprising. ...
GenerationPMTO is a theory- and evidence-based behavioral parenting program widely implemented in the past three decades. This systematic review and meta-analysis examined the effectiveness of twenty GenerationPMTO studies on parenting and child adjustment among 3893 families in six countries. Hedges’ g from studies with pretest–posttest-controlled designs were computed and robust variance estimation (RVE) was used to deal with the effect size dependency. Results showed that GenerationPMTO significantly promoted parenting and child adjustment with moderate to high levels of heterogeneity. Specifically, GenerationPMTO improved parental discipline, parenting monitoring, skill encouragement, child externalizing problems, and child internalizing problems. Subgroup analyses revealed several important moderators, including type of comparison group, measurement, informant, risk of bias, etc. Intervention effects were quite robust across countries and multiple demographic characteristics. No publication bias across studies for parenting and child adjustment was detected. The revised Cochrane risk of bias for randomized trials (RoB 2) procedure was used to assess risk of bias within the included studies. Some studies showed a higher level of risk due to problems with the randomization process, missing data, low measurement quality, and reporting bias. Due to lack of data, we did not examine intervention effects on parental mental health or couple relationship quality. Future studies should test mediation models to understand the mechanisms of change and to identify moderators in order to understand the high levels of heterogeneity in GenerationPMTO studies.
... Findings show the positive effects of Positive Parenting Program on child development and parental outcomes. A systematic review and meta-analysis by Sanders et al 9 examined over a hundred of Triple P-Positive Parenting Program studies spanning over 33 years of research. The study suggested the short-and long-term positive effects of Positive Parenting Program on child social-emotional development and behaviors and parenting practices. ...
... Besides, Triple P was also found to improve parental efficacy, parental relationships, and parental adjustment. 9 An evaluation by Zubrick et al 10 assessed the effectiveness of a Triple P-Positive Parenting Program conducted in Australia. The study suggested the reduction of child behavior problems after the parents participated in the Triple P. 10 Another Australian study 11 indicated similar results as the Triple P was effective in reducing child disruptive behavior, dysfunctional parenting, conflicts between parents over child rearing, and parental mental health problems. ...
Introduction:
Child development receives lack of concern and the role of parents in promoting child development is not frequently mentioned in Vietnam. This study aimed to examine the effectiveness of Positive Parenting Program to Promote Child Development on maternal knowledge and practice and development of children aged 1 to 3 years.
Methods:
This is a quasi-experimental study conducted in Nha Trang city, Vietnam. There are a total of 60 mothers whose children were identified as suspected developmental delayed participated in the study. There were 30 mothers who attended the program as experimental group and 30 mothers who joined the study as comparison group. Ages and Stages Questionnaires, Third Edition (ASQ-3) were applied to assess the child development. Descriptive analysis and paired and independent-samples t-test were applied to examine the research objectives.
Results:
The findings suggested that after the program implementation, the maternal knowledge of child development and child development of the experimental group were significantly higher than pre-program and the improvements of these variables were better than the comparison group (P < .05) while the maternal practice to promote child development was significantly better only within the experimental group.
Conclusions:
The program was effective in improving several maternal outcomes and child development. The study recommends applying the Positive Parenting Program to Promote Child Development to enhance mother's knowledge of child development and child development.
... Besides the popular Triple P-Positive Parenting Programme aimed at preventing behavioural and emotional problems in children and adolescents 22,23 , other positive parenting programmes were effective in reducing parents' mental health problems and children's behavioural and emotional problems, especially disruptive behavioural disorders 22,24-28 . Moreover, parent training programmes are associated with better social, emotional, and behavioural outcomes for the child, which in turn improve the parent-child relationship, parenting skills, and parental competencies 22,23 . The effectiveness of the positive parenting programme has made it highly recommended as a primary intervention 29 . ...
... As a result, the efficacy of the intervention in reducing behavioural concerns did not differ significantly between the intervention and control groups. This study, along with previous work by Sanders and team, found that both online parent training and self-help workbooks were effective in reducing disruptive behaviours 23 . ...
Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3–6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children’s emotional problems at 14 weeks (mean change: Intervention = − 0.44, p = 0.033; Control = − 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency.
Clinical trial registration Thai Clinical Trials Registry; https://www.thaiclinicaltrials.org/ ; TCTR20201030001; October 30, 2020.
... There is increasing support for the scaling up of evidence-based parenting programs to reduce the prevalence of child mental health problems and rates of child maltreatment (Prinz & Shapiro, 2018;. These interventions result in positive changes in parent behavior, child behavior, parental adjustment, and family relationships (e.g., Sanders et al., 2014), have been shown to be acceptable to a wide range of parents and to be effective in very diverse cultural contexts (Haslam & Mejia, 2018). Further, parenting programs are very cost-effective (e.g., Sampaio et al., 2018), resulting in considerably more savings in other social services than the cost of implementing them (Bachmann et al., 2021;Washington State Institute for Public Policy, 2019). ...
... For example, the Triple P system is built on a substantial foundational evidence base comprising several hundred studies conducted over four decades that include evaluations of program variants using randomized controlled trials; population-level evaluations; service-based evaluations; single case experiments; qualitative studies; consumer acceptability studies; evaluations of training, supervision and implementation methods; and economic analyses (see pfsc.uq.edu.au/evidence). Multiple metaanalyses of Triple P have documented consistent medium-sized intervention effects on diverse child and parent outcomes (e.g., Sanders et al., 2014). Programs with insufficient empirical support should not be disseminated or become part of the intervention system (Sanders & Mazzucchelli, 2018b). ...
Objective:
Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes.
Method:
Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention.
Results:
A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved.
Conclusions:
Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.
... Behavioural family interventions based on social learning principles are an effective treatment for behaviour problems in children (Dretzke et al., 2009). For example, the Triple P Positive Parenting Program has an extensive body of evidence demonstrating the effectiveness of the programme in reducing children's behaviour problems and dysfunctional parenting practices, and increasing positive parenting practices (Sanders, Kirby, Tellegen, & Day, 2014). ...
... The Triple P Positive Parenting Program is a multi-level system of parenting support, based on social learning principles, which has demonstrated effectiveness across cultures (Sanders, Kirby, et al., 2014;Turner, Singhal, McIlduff, Singh, & Sanders, 2020). The system includes programmes of varying intensity. ...
The study was a randomised controlled trial evaluating the effectiveness of the Group Triple P Program for Chinese immigrant parents living in New Zealand. Sixty-seven Chinese immigrant parents of a 5- to 9-year-old child with disruptive behaviour problems were randomly allocated to either an intervention or a waitlist group. Parents completed measures of child adjustment problems, general parenting practices, parenting practices in children's academic lives, parental adjustment, parental teamwork, and family relationships at pre-, post-, and 4-month follow-up. Intervention group ratings of programme satisfaction were collected following programme completion. Significant short-term intervention effects were found for improvements in child behaviour, parenting practices, parental teamwork, and parenting in the child academic context. All intervention effects, except for parental teamwork, were maintained at 4-month follow-up. There were no significant intervention effects for parental adjustment, however, medium effect sizes were found at post-intervention and follow-up. A high level of programme satisfaction was reported.
... The Positive Parenting Programme (Triple-P), for example, a well-established intervention targeting child mental health outcomes via improvements in parenting, includes an additional component targeting positive partner support if mothers are depressed (enhanced Triple-P: S. H. Goodman & Garber, 2017). A meta-analysis of Triple-P interventions identified small improvements in the parental relationship when families attended enhanced versus standard Triple-P, along with improved child behavioural and emotional outcomes (Sanders et al., 2014). ...
... When mothers experience depression symptoms and positive father behaviour is low, intervening to help fathers improve their parenting and better support their partners may maximise gains in child mental health outcomes. This echoes findings from clinical studies: when mothers are depressed, interventions have been found to produce long-term reductions in child mental health symptoms, especially when both parenting and partner support are targeted (Sanders et al., 2014). Our findings lend further weight to the importance of engaging fathers effectively in such interventions. ...
Abstract Background Maternal depression, especially when severe and long‐lasting, is associated with adverse mental health outcomes in children. We aimed to assess, for children of mothers with persistent postnatal depression symptoms, whether positive father behaviours would decrease risk for conduct and emotional symptoms. Methods Using data from 4009, mother–father–child trios from the Avon Longitudinal Study of Parents and Children we examined associations between maternal depression trajectories and positive father behavioural profiles across the postnatal period (child age: 2–21 months), and child conduct and emotional symptom trajectories across middle childhood (child age: 3.5–11 years). Results Positive father behaviour was much less common in families where mothers experienced high‐persistent depression symptoms (33%) than in families where mothers did not (56%); of note, these fathers also had higher levels of depression symptoms. Using person‐level analysis, exposure to high‐persistent maternal depression symptoms increased child risk for a high trajectory of both conduct (odds ratio, 2.69; 95% CI: 2.00, 3.60) and emotional symptoms (odds ratio, 2.47; 95% CI: 1.83, 3.31). However, positive father behaviour (toward child and mother) reduced the odds of following high trajectories of conduct symptoms by 9% (x = 4.52, p
... Positive parenting attitudes are important precursors to the use of adaptive parenting behaviors, especially during the transition to parenthood (Leerkes & Crockenberg, 2002). In addition to parenting behaviors, parenting attitudes are an essential component of parenting interventions and exert unique influences on the parent-child relationship and subsequent child outcomes (Albanese et al., 2019;Sanders et al., 2014). Thus, it is important to understand the ways in which early parenting experiences may shape mothers' parenting attitudes. ...
... This study addresses a gap in existing research by providing novel evidence suggesting that mothers' perceived parenting histories are both directly and indirectly associated with their parenting attitudes while highlighting the role of stress and depression as underlying mechanisms. Our findings emphasize the importance of parenting interventions designed to reduce children's development of stress and depression, thereby providing a foundation for their later development of positive parenting attitudes during their own transition to parenthood (e.g., Sanders et al., 2014). Such interventions should aim to reduce parents' use of psychologically controlling and manipulative parenting strategies by promoting warmth, support, acceptance, and respect toward children. ...
Patterns of parenting behaviors tend to persist across generations, but less is known about the associations between mothers’ perceived histories of parenting and their current parenting attitudes. The present study examined stress and depression as potential mechanisms through which mothers’ perceived histories of maternal and paternal support and psychological control may be associated with their current parenting self-efficacy and satisfaction. Participants were 192 mothers of infants who participated in early home visiting services. Participants reported on their mothers’ and fathers’ use of support and psychological control during childhood, as well as their own current levels of stress and depression. Two months later, participants completed questionnaires assessing their parenting self-efficacy and satisfaction. Results indicated both direct and indirect associations between mothers’ perceived histories of parenting and their current parenting attitudes. Mothers’ perceptions of maternal support predicted higher parenting self-efficacy, and their perceptions of paternal psychological control predicted lower parenting satisfaction. Mothers’ experiences of depression fully mediated the associations between their perceptions of both maternal and paternal psychological control and their parenting satisfaction. Additionally, mothers’ experiences of stress and depression fully mediated the association between their perceptions of paternal psychological control and their parenting self-efficacy. Our findings highlight stress and depression as potential underlying mechanisms in the association between mothers’ early parenting experiences and their current parenting attitudes. Preventive interventions targeting parenting behaviors during childhood and mothers’ emotional experiences during their transition to parenthood may promote more positive parenting attitudes.
... Positive transformation of parental roles through parenting education would tremendously benefit children's growth and development [3]. In addition, parental education helps reduce maternal depression and stress, increases parental satisfaction and efficiency, and reduces problems related to parenting [1]. ...
Purpose:
This systematic review and meta-analysis investigated the effects of parenting education programs (PEPs) for refugee and migrant parents.
Methods:
A systematic review was conducted according to PRISMA guidelines. Relevant studies published from 2000 to 2020 were identified through a systematic search of six electronic databases (PubMed, Embase, Cochrane Library, CINAHL, RISS, KMBASE). A meta-analysis of the studies was then undertaken.
Results:
Of the 14,996 published works identified, 23 studies satisfied the inclusion criteria, and 19 studies were analyzed to estimate the effect sizes (standardized mean differences) of the PEPs using random-effect models. PEPs were effective for parenting efficacy (effect size [ES]=1.40; 95% confidence interval [CI]: 1.14-1.66), positive parenting behaviors (ES=0.51; 95% CI: 0.30-0.73), parent-child relationships (ES=0.38; 95% CI: 0.22-0.53), and parenting stress (ES=0.64; 95% CI: 0.50-0.79). There were statistically significant differences in the effect sizes of PEPs that included mothers only (ES=0.93), included children under 7 years of age(ES=0.91), did not include child participation (0.77), continued for 19 or more sessions (ES=0.80), and were analyzed in quasi-experimental studies (ES=0.86). The overall effect of publication bias was robust.
Conclusion:
PEPs were found to be effective at improving parenting efficacy, positive parenting behaviors, parent-child relationships, and parenting stress.
... A large body of evidence supports the efficacy of behavioral parenting interventions (for a meta-analysis see Sanders et al. 14 ). Evidence-based behavioral parenting interventions focus on increasing parents' knowledge, skills and confidence, 14,15 and have been effective in improving child health outcomes such as child weight management. [15][16][17] Behavioral parenting training includes a toolbox of practical skills and resources, such as effective strategies for praising, encouraging, and supporting children as they learn new skills. ...
In pediatric cancer care, medication non-adherence is a significant driver of avoidable suffering and death. There is a lack of interventions designed for families of young children, where patient medication refusal/avoidance is a common barrier to adherence. We developed the CareMeds intervention which focuses on caregiver skills training to help young children take medicine calmly and without use of restraint techniques. The goal of this preliminary study was to assess the acceptability and feasibility of the CareMeds intervention. Caregivers of pediatric cancer patients (ages 2-10) whose children were on a home-based oral medication regimen were recruited to participate. Feasibility was examined through study enrollment and retention rates as well as reasons for refusal and drop out. Acceptability was evaluated through usability of and engagement with intervention components and an acceptability questionnaire. Feasibility: We recruited N = 9 caregivers to participate in this intervention pilot study and had a 75% enrollment rate. Reasons for declining included scheduling concerns (n = 2) and lack of interest (n = 1). The participant retention rate was 100% with 100% adherence to intervention sessions. Acceptability: Parents rated the sessions and resource materials as acceptable and reported frequent use of skills taught in the intervention. The CareMeds intervention is an acceptable and feasible strategy for caregivers of pediatric cancer patients and warrants future research to examine the efficacy of behavioral parenting skills interventions to improve medication adherence in young children.
... First, we anticipated that parents who experienced more difficulties providing affiliation, structure or autonomy support at pre-intervention (i.e., who scored a standard deviation below average on a given parenting component) would benefit more from the program than those experiencing fewer difficulties at pre-intervention, presumably because they would be less familiar with its skills. Second, based on meta-analytic reviews of other parenting programs using a universal approach, we did not expect child age nor child sex to moderate the program's efficacy (e.g., de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008), but hypothesized that any parent gender difference would result in larger positive changes for mothers than fathers (e.g., Fletcher, Freeman, & Matthey, 2011;Sanders, Kirby, Tellegen, & Day, 2014), arguably because mothers are more likely to be primary caregivers (Galinsky, Aumann, & Bond, 2013;Milan, Keown, & Urquijo, 2011). To describe our Method and Results sections, we follow the CONSORT standard guidelines for social and psychological interventions (Montgomery et al., 2018). ...
“How to Talk so Kids will Listen & Listen so Kids will Talk” is a universal parenting program hypothesized to teach three key parenting components: autonomy support, affiliation, and structure. To assess its impact on these components, we conducted its first randomized controlled trial. We recruited 293 parent-child dyads, which we randomized into 30 parenting groups. Fifteen groups received the program immediately (How-to condition), while the other half received it 14 months later (waitlist condition). Parents and their child (Mage = 7.60) rated parent autonomy support, affiliation and structure at pre- and post-intervention as well as at six- and twelve-month follow-ups. At post-intervention, parents in the How-to condition reported more autonomy support than parents in the waitlist condition and, for those scoring low on affiliation or structure at pre-intervention, more affiliation and (potentially) structure, respectively. Limited differences were reported by children. Post-intervention differences remained stable over the 12-month follow up.
... Family counseling (Hernandez, 2016;Nickel et al., 2006) and formal programs like parent management training (Kazdin, 2008) and functional family therapy (Fiese et al., 2019;Sexton, 2011) can help address longstanding problematic parent-child relations. Behavioral family interventions such as the Positive Parenting Program can produce a clinically-significant reduction in observed disruptive conduct by children (Bor et al., 2002;Sanders, 2008;Sanders et al., 2014), while other evidence-based treatments such as parent-child interaction therapy (Eyberg & Bussing, 2011;Kimonis & Armstrong, 2012) also show promise in attenuating disruptive behavior among young children. To be sure, successful outcomes for children largely depend on whether parents fully engage with and complete any prescribed intervention (Hood & Eyberg, 2003). ...
Bullying and cyberbullying prevention remain a major priority for schools, communities, and families, and research is clear that positive, constructive parenting practices can play a key preventive role. The current work explores six dimensions of parenting (warmth, structure, autonomy support, rejection, chaos, and coercion), and their specific relationship to school and online bullying. Using survey data from a nationally representative sample of 1474 English-speaking 12- to 17-year-old US youth, we found that students whose parent(s) exhibit warmth, structure, and autonomy support are less likely to have engaged in bullying or cyberbullying offending, while those with parental relations marked by rejection, chaos, and coercion are more likely to have participated in both forms of peer aggression. Implications for developing stronger parent-child relationships through improved parenting practices as a mechanism for bullying prevention are discussed.
... Could the pandemic have improved familial relationships as individuals begin to spend more time together or worsen relationships such as in the case of toxic or abusive homes? This suggests that interventions that aim to bolster parenting education, such as culturally responsive whole-family programs and services with a focus on the parent-child relationship, warrant further study [24]. ...
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the mental health and wellbeing of Ontario's youth. Our study investigated the psychological impacts of COVID-19 on the pediatric population of Ontario, using a survey derived from the Revised Children's Anxiety and Depression Scale (RCADS) system to identify children who may benefit from seeking professional help. Our cross-sectional study examined the potential risk factors that contributed to worsening mental health and wellbeing in children, including changes in sleep patterns, appetite, and physical activity levels, as well as the diagnosis of a family member with COVID-19. Our study found that 24%, 9.4%, and 15.5% of participants exhibited symptoms of depression, anxiety, and obsessive-compulsive disorder (OCD), respectively, according to the RCADS system. Furthermore, there were significant associations between the presence of symptoms and the diagnosis of a family member with COVID-19 or a frontline worker in the family. This suggests a need to create interventions to support the families of frontline workers and those directly affected by a COVID-19 diagnosis.
... We conducted the toddler safety promotion intervention at two community sites and focused on four toddler safety areas: fire prevention, fall prevention, poison control and car seat use [9]. Following the Triple P-Positive Parenting Program [11], a highly effective evidence-based parenting programs, the intervention included eight sessions led by health educators grounded in social cognitive theory principles, which emphasizes interactions among people (personal factors), their behavior, and their environments [12]: five in-person group sessions including a final review/celebration session, and three individual phone sessions. Group activities were designed to help mothers build safety knowledge, encourage peer modelling, promote perceived importance in toddler safety, provide social support and build selfconfidence in adopting safety strategies. ...
Objective
Little is known about the association between maternal depressive symptoms and attendance at safety promotion interventions. This study used latent class analysis (LCA) to identify the profile of attendance within a toddler safety intervention and assessed its relation with maternal depressive symptoms at baseline and reduction of home safety problems over time, separately.
Methods
The analytic sample included 91 mothers of toddlers (mean maternal age 28.16 years) who were assigned to the safety promotion intervention group as part of a randomized trial and assessed at baseline, 6-month and 12-month follow-ups. Using LCA, we classified mothers into low and high attendance classes based on their attendance at 8 intervention sessions. We assessed maternal depressive symptoms with the Beck Depression Inventory (BDI) and home safety problems with a 9-item home safety problem observation.
Results
The mothers were classified into low attendance (45%) and high attendance classes (55%). The posterior probability of attending each session ranged from 0–0.29 for the low attendance class and 0.68–0.92 for the high attendance class. Each one unit increase of BDI sum score at baseline was associated with an 8% reduced odds of being in the high attendance class (aOR = 0.92, 95% CI: 0.86, 1.00, p = 0.037). The home safety problem score reduction was greater among high attendance class participants than low attendance class participants at the 6-month follow-up (b = -1.15, 95% CI:-2.09, -0.20, p = 0.018).
Conclusion
Maternal depressive symptoms were associated with the reduced probability of maternal attendance at toddler safety promotion sessions; high session attendance was related to greater reduction of toddler home safety problems. Identifying risk factors for maternal low attendance to interventions and developing strategies to promote attendance should lead to reductions in home safety problems and reductions in unintentional injuries among young children.
... Le Triple P-Positive Parenting Program (Triple P) [20], quant à lui, comprend cinq niveaux d'intervention, allant de stratégies de prévention universelles à un traitement intensif et individualisé ciblant les enfants présentant des symptômes graves de trouble des conduites. Il a été conçu pour être utilisé avec les parents de la naissance à l'âge de 16 ans, bien que la majorité des recherches se soient concentrées sur les familles d'enfants de 2 à 8 ans [21]. Le Triple P combine des stratégies d'entraînement parental avec une gamme de matériels et de services de soutien aux familles. ...
L’objectif de cette revue critique est de présenter les caractéristiques des principaux programmes d’entraînement aux habiletés parentales (PEHP) et leurs effets sur les troubles du comportement externalisé chez les enfants et leur perception par les parents. Ces programmes sont fondés sur des principes théoriques du conditionnement opérant et de l’apprentissage social. Les résultats de leurs évaluations révèlent des effets significatifs chez les parents avec une réduction du stress parental et une augmentation du sentiment de compétence parentale et chez les enfants avec une réduction des comportements agressifs. Cependant, ces résultats prometteurs doivent être confirmés en raison de plusieurs limites méthodologiques : une forte hétérogénéité des caractéristiques sociodémographiques des familles et des procédures de recrutement ainsi qu’une grande variabilité des outils utilisés pour évaluer leurs effets. Les résultats sont discutés d’un point de vue théorique et méthodologique et aussi d’un point de vue clinique.
... Levels 2-5 offer increasingly intensive supports to parents through individual and group sessions, with lower levels for families struggling with minor to moderate challenges and the fifth level for families experiencing family conflict. Triple P has been rigorously evaluated in multiple studies and found to improve parenting practices, parental relationships, and children's social, emotional, and behavioral skills (Sanders et al., 2014). ...
Exposure to severe, chronic, and cumulative adversity during sensitive periods of development such as early childhood places children at immediate risk of harm and has been linked to many of the most common physical and mental health problems later in adulthood. However, recent advances in neuroscience, developmental psychology, social work, and related fields demonstrate that early childhood is also a period of great opportunity for promoting resilience in development, as early life experiences have a strong influence on young children’s brain development, gene expression, social and emotional well-being, and learning. This chapter provides an overview of resilience theory and related frameworks for understanding competence in the face of adversity and provides examples of evidence-based interventions and protective factors that are aligned with this approach. Extrapolating from the scientific literature to date, we discuss implications for nurturing resilience among young children and their families and related implications for policymakers, practitioners, and researchers. Finally, we consider next steps for growth in the field.
... One of the advantages of measuring parenting confidence is that improvements in parents' perception of their own parenting have been achieved through interventions. After participation in short-term parenting training programs, parenting self-efficacy was enhanced in mothers with infants [58] and in various caregivers (for a review, see [59]). For the link between knowledge of child rearing and confidence [19], even a parenting workshop that educates struggling parents regarding basic knowledge of parenting may benefit children during the aftermath of a disaster. ...
After the 2011 Fukushima Daiichi Nuclear Power Station accident, the Fukushima Health Management Survey was conducted to assess children’s lifestyle and mental health conditions. The participants in this study were 1126 children, aged 0 to 3 years, living in the evacuation zone at the time of the disaster. The parenting confidence of their mothers was assessed using a self-administered questionnaire as a baseline in 2013. We examined the association of parenting confidence level at baseline, using a total difficulty score of the Strengths and Difficulties Questionnaire (SDQ) and reluctance to attend school among children in a follow-up study in 2016 and 2017. As a result, no confidence was reported by 178 (15.8%) mothers, while 477 (42.4%) responded with “not sure” and 471 (41.8%) were confident. In the multiple logistic analysis, after adjusting for covariates such as the child’s sex, age, and current health condition, the group lacking parenting confidence demonstrated a significantly higher risk level for SDQ total difficulties (OR, 2.8; 95% CI, 1.59–4.93) and reluctance to attend school (OR = 1.98, 95% CI: 1.24–3.18) than the confident mothers. After a major disaster, which can have long-term effects on communities, intensive psychological care for mothers with young children is needed to prevent various mental health problems in their children.
... Behavioral parent training (BPT) has garnered overwhelming support since the 1970s as the most effective intervention for children with behavioral problems (Kaminski & Claussen, 2017;Michelson et al., 2013). Group BPT programs such as Incredible Years and Triple P have been disseminated around the globe, with reach into 26 countries across 25 languages and have over 200 randomized controlled trials to support their effectiveness (Sanders et al., 2014;Webster-Stratton & Reid, 2018). Unfortunately, parental negative attributions and mental illness often prevent engagement and perseverance with well-proven behavioral techniques, contributing to a drop-out rate of up to 50% (Chacko et al., 2016). ...
Objectives
While mindfulness-based parenting programs (MPPs) are increasingly popular for reducing child behavior problems, the evidence for the advantages of MPP over existing behavioral parent training is unclear. Existing systematic reviews have largely excluded the breadth of MPP protocols, including those that integrate behavioral skills components. Therefore, a scoping review was conducted to map the nature and extent of research on MPPs for parents of children aged 3 to 12 years with behavioral problems.
Methods
PRISMA-ScR guidelines were used to conduct an encompassing peer literature review of cross-disciplinary databases. Studies were included if they reported mindfulness interventions for parents of children aged between 3 and 12 years with externalizing behavior problems and had an outcome measure of child behavioral problems that could be represented as an effect size. Randomized controlled trials as well as quasi-experimental, pre-post studies and unpublished dissertations were included.
Results
Sixteen studies met the inclusion criteria (N = 1362). The majority of MPPs delivered mindfulness adapted to parenting based on the Bögels’ protocol within clinical settings. There was a dearth of fully integrated mindfulness and behavioral programs. MPPs generally produced pre-to-post-intervention improvements with small effect sizes across child behavior and parent style, stress, and mindfulness measures. Examining longer follow-up periods compared to pre-intervention, effects reached a moderate size across most outcome measures.
Conclusions
MPPs continue to show promise in improving child behavior and parental mindfulness, well-being, and style. Further research is needed to determine how to best leverage the advantages of mindfulness in augmenting the well-established effectiveness of behavioral programs.
... Regarding evidence-based manualized interventions, the child-directed interaction training program included parentchild interaction therapy and parent-directed interaction, which aimed to enhance the caregiver-child interactions and reduce children's behavioral problems (Eyberg et al., 2008;Funderburk & Eyberg, 2011). Behavioral parenting training was a modified version of the Triple P-Positive Parenting Program, which is a parenting support program to reduce emotional and behavioral problems of children via strengthening parenting skills (Sanders, Kirby, Tellegen, & Day, 2014). The cognitive-behavioral therapy in Smith et al.'s (2018) study was adapted from the Coping with Caregiving (CWC) program, which was originally for caregivers of persons with dementia (Gallagher- Thompson et al., 2002). ...
Purpose: This systematic review aims to examine the effectiveness of interventions that seek to improve outcomes of grandchildren raised by grandparents. Method: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. We searched in ERIC, Family Studies Abstracts, PubMed, PsycINFO, Social Work Abstracts, Sociological Abstracts, Web of Science, and Google Scholar. Results indicated that grandchildren who participated in these interventions had improvement in their socio-emotional, mental, and behavioral outcomes but had mixed educational outcomes, regardless of research designs and evaluation methods. Two out of eight studies were of high quality, while the rest needed improved rigor in designs and analyses. Conclusions: The review summarized evidence for interventions to improve grandchildren’s outcomes and pointed out directions for future research and practice.
... As one example, Professor Matt Sanders and colleagues from the Parenting and Family Support Centre at the University of Queensland in Australia developed the Triple P -Positive Parenting Program® to enhance parents' knowledge, skills, and confidence in managing family issues (Sanders, 2008). Meta-analysis has found the program can enhance parents' wellbeing and satisfaction as well as child social, emotional, and behavioral outcomes (Nowak & Heinrichs, 2008;Sanders et al., 2014). ...
... Schilling, Lanier, Rose, Shanahan, and Zolotor (2020) explain that the program is based on five principles: (i) ensuring a safe, engaging environment; (ii) promoting a positive learning environment; (iii) using assertive discipline; (iv) maintaining reasonable expectations; and (v) taking care of oneself as a parent. Structured from five levels of intervention and based on flexible strategies that adapt to the diversity of the participants, this is an example of how it is possible to achieve effective change in family contexts with high exposure to stress and in promoting positive changes in situations of adversity (see also Sanders, Kirby, Tellegen, & Day, 2014). One goal of the program, for example, is that the parents change their children's conceptions of behavior, as well as their own reactions to unwanted behaviors. ...
Using a qualitative case study approach, this study aimed to investigate the family context in the childhood of adults who themselves have been violent toward their own children. The study, conducted in Brazil, included the participation of three adults, of both genders, who were neglectful as well as physically and psychologically violent toward their children. Data collection was carried out using the Interview About the Past of Parents (IAPP) and family genograms. Findings demonstrate factors that contribute to the perpetuation of violence across generations, and explain the difficulties in breaking cycles of violence. Importantly, findings highlight how the discipline practices used with their own children were reproductions of the models of parenting and related manifestations of violence that the participants themselves were exposed to in childhood. From these findings, the importance of psychosocial interventions that assist family members in replacing coercive parenting practices with healthier strategies is reiterated.
... Despite increasing evidence of the benefts of emotion coaching in the context of emotion socialisation and, subsequently, in children's emotional development, practical applications of these ideas in targeted interventions have been slow to emerge. Instead, for the last 50 years, the evidence-based literature has been dominated by behavioural management parenting programmes, such as Triple P [71] and the Oregon model of Parent Management Training [34], which typically have little to no focus on parental responses to children's emotions and instead place the emphasis on responding to behaviour. ...
Emotion-related parent-child interactions during early childhood play a crucial role in the development of emotion regulation, a fundamental life skill central to well-being. However, limited work in HCI has explored howtechnology could support parents in adopting supportive emotion socialisation practices. In this paper, we explore how an embodied, in-situ intervention in the form of a smart toy can impact emotion-related parent-child interactions in the home. We draw on (1) interviews with 29 parents of young children who had the smart toy for at least 1 month; (2) co-design workshops with 12 parents and 8 parenting course facilitators. We discuss how the smart toy impacted parent-child interactions around emotions for a subset of families, and draw on workshop data to explore how this could be designed for directly. Finally, we propose a set of design directions for technology-enabled systems aiming to elicit and scafold specifc parent-child interactions over time.
... A meta-analysis identified four components of parenting skills training that had the largest effects on reducing externalizing behaviors in children: increasing positive parent-child interactions, teaching parents how to communicate emotionally with their children, teaching parents the use of time out as a means of discipline, and supporting parents to consistently respond to their children's behaviors [21]. The Triple P Positive Parenting Program [22] is successful in preventing and managing aggressive behaviour in children. Circle of Security, an attachment-based parenting intervention, reduced externalising tendencies in children in an Australian clinical trial [23]. ...
Purpose: To conduct a systematic review study of school based interventions to decrease aggressive behaviour among adolescents. The main goal of this review is to know about various interventions and to evaluate the effect of interventions on aggressive behaviour. The study's second goal is to find research gaps that could lead to more research in this area. The findings could be used as a foundation for developing interventional programs aimed at reducing adolescents' aggression. Design/Methodology/Approach: The purpose of this study is to develop a module as coping techniques to reduce the aggressive behaviour and analyse the ABCD model of the same. For this purpose we conducted a search 122 articles for relevant articles in the specified area. We looked for articles published between 2000 and 2022 using the primary databases; Google Scholar, Research Gate, Academia, SSRN, Shodhganga, PubMed, Rayyan and Elsevier. The words like aggressive behaviour, interventions and aggression were used for searching articles. All abstracts and entire articles were scrutinized to see various interventions as a coping strategy to decrease aggressions among students. Findings/Result: These findings reveal a clear link between self-control abilities and aggressive behaviour: those with greater self-control have less aggression, while people with lower self-control have more aggression. This relationship shows to hold true across a range of ages i.e. from childhood onwards. Based on these review study it also discussed and put forward future research into various interventions and strategies for regulating aggressiveness. Originality/Value: This review summarizes selected studies identifying the effect of various interventions on aggressive behaviour and find out the coping strategies. The future direction of existing research on emotional stability, first focusing on stressors and barriers associated with aggressive behavior, and considering the increased risk of stress, anxiety, and depression reported in this population. Next, it then describes recent trends and issues and seeks to fill gaps in existing literature that require additional research effort. We also conclude that there exists a need for future research on psychological intervention and coping strategies, cognitive behavioral therapy, parent management training, anger rumination and relaxation therapy for enhancing emotional well being and self-control of adolescents. Implementing parental interventions in parallel with the child's interventions may raise mental health.
... In this trial, following the recommendations of Whitehead et al. (2016), a sample size of 15 families per arm will be required with 90% power and two-sided 5% significance [35] and medium effect size (Cohen's d = 0.5) based on meta-analysis of the effects of the Triple P on parenting and child outcomes [36]. Allowing for an attrition rate of 60%, 25 participants will be recruited to each arm. ...
Introduction:
Obesity and overweight are significant health problems among Australian children. Parents play a vital role in establishing healthy eating behaviors in their children. However, parents often experience difficulties in implementing effective parenting practices and lack confidence in their ability to help children adopt these behaviors. This trial will evaluate the efficacy of an online program, Healthy Habits Triple P, in improving children's snacking and mealtime behaviors and related parenting practices.
Methods and analysis:
This is a single-blinded, randomized controlled trial for parents of young Australian children aged 2-6 years. Participants will be recruited through childcare centers, social media, online parent forums and existing networks. The participants in the intervention arm will receive access to a web-based parenting intervention in addition to nutrition-related information for parents published by the National Health and Medical Research Council of Australia; those in the control arm will receive nutrition-related information only. After the completion of the study, the parenting intervention will be offered to the control arm. The primary outcome will be improvement in children's eating habits. The secondary outcomes include parents' self-efficacy, confidence, children's mealtime behaviors and mealtime parenting strategies. Both primary and secondary outcomes will be evaluated through online-administered, validated parent-reported questionnaires. We will also undertake a quantitative and qualitative evaluation of the practicality and acceptability of the intervention.
... Early interventions may be a good solution to promote nurturing environments and parent and baby interaction because the potential benefits of these interventions in the general population have been largely accepted, especially in relation to child outcomes (14)(15)(16)(17)(18)(19). The Triple P system of interventions is a major contribution to the parenting intervention research with solid theoretical, scientific and clinical foundations (20)(21)(22)(23)(24)(25). Triple P interventions are aimed at contributing to the healthy development of children by enhancing parental knowledge and resourcefulness regarding positive parenting practices. ...
Background
Approximately 1–2% of mothers may experience severe mental illness (SMI) requiring admission to an inpatient Mother and Baby Unit (MBU). MBUs aim to provide mental health assessment and treatment and strengthen the mother-infant relationship, essential for infant development. Whilst MBUs offer various interventions, they do not routinely offer structured parenting interventions. The Baby Triple P Positive Parenting Program (BTP) was developed to enhance parenting competence, psychological coping and the quality of partner and other social support. Guided by lived experience consultation, we aimed to determine the feasibility and acceptability of delivering BTP plus Treatment as Usual (TAU) in this setting.MethodA multi-site, parallel-group, single-blind pilot randomized controlled trial (registration: ISRCTN12765736) comparing BTP+TAU to TAU in participants, recruited from two MBUs in England. The Baby Triple P intervention consisted of eight parenting sessions, with the final four being delivered over the telephone following MBU discharge. Feasibility outcomes were participant intervention engagement and study retention. Clinical outcomes including maternal parenting competence, bonding and mental health outcomes were assessed at baseline, post-baseline/intervention (10 weeks) and six-month follow-up. Data were analyzed using descriptive statistics and linear regression models. An economic feasibility analysis was also conducted.ResultsThirty-seven of the 67 eligible participants consented; 34 were randomized (16 to BTP+TAU and 18 to TAU), of whom 20 were retained at post-intervention data collection and 21 at six-month follow-up. Twelve participants (75%) completed the intervention, which was rated as highly acceptable. Clinical outcomes signaled potential improvements in maternal parenting competence, bonding, mood and mental health symptomatology in participants who received the intervention. Healthcare resource use and EQ-5D-5L questionnaires were well-completed by participants. Delivering BTP in this setting is estimated to cost £443-822 per participant.Conclusions
This is the first trial of a parenting intervention in a MBU setting. BTP is feasible and acceptable to mothers with SMI, with a promising signal for treatment efficacy. Although minor modifications may be required for the collection of observer-rated measures post-MBU discharge, the findings indicate that a larger, definitive trial could be conducted, especially if the setting is extended to include perinatal mental health community settings.
... For example, interventions during pregnancy and after birth that integrate positive psychological components, including gratitude journaling and mindfulness, may reduce mothers' perceived stress and symptoms of depression and increase positive affect [68,69]. Research further suggests that parenting interventions can increase levels of parental self-efficacy and positive affect [70]. Higher parental selfefficacy has been associated with positive parenting behaviors including increased sensitivity, warmth, and responsiveness [71], which can protect against the development of children's mental health problems [54][55][56]71]. ...
Positive maternal mental health can improve perceptions of stressful situations and promote the use of adaptive coping strategies. However, few studies have examined how positive maternal mental health affects children’s development. The aims of this study were to examine the associations between positive maternal mental health and children’s internalizing and externalizing symptoms, and to ascertain whether positive maternal mental health moderated the associations between prenatal stress and children’s internalizing and externalizing symptoms. This study is based on the Norwegian Mother, Father, and Child Cohort Study (MoBa), and comprised 36,584 mother–child dyads. Prenatal stress was assessed using 41 self-reported items measured during pregnancy. Positive maternal mental health (self-efficacy, self-esteem, and enjoyment) was assessed by maternal report during pregnancy and postpartum. Child internalizing and externalizing symptoms were assessed by maternal report at age 5. Structural equation modeling was used for analysis. Maternal self-efficacy, self-esteem, and enjoyment were negatively associated with internalizing and externalizing symptoms in males and females. The association between prenatal stress and internalizing symptoms in males was stronger at low than at high levels of maternal self-esteem and enjoyment, whereas for females, the association was stronger at low than at high levels of maternal self-esteem and self-efficacy. This study provides evidence of associations between positive maternal mental health and children’s mental health, and suggests that higher positive maternal mental health may buffer against the impacts of prenatal stress. Positive maternal mental health may represent an important intervention target to improve maternal–child well-being and foster intergenerational resilience.
... Le verifiche sperimentali delle ricerche internazionali hanno evidenziato che questi possono ottenere buoni livelli di efficacia, se adeguatamente progettati (es. d = 0,43 del «PPP» di Sanders et al., 2014). perché le buone pratiche di «genitorialità positiva» possano essere valorizzate e condivise. ...
Foster care is a condition of welcoming children with families in serious difficulty, legally regulated, aimed at guaranteeing to minors a suitable space for growth, and to families of origin the possibility of overcoming the problems so as to consent the return of the children. It is a challenging educational condition, to be deepened with research. The complexity of the backgrounds of origin and the co-presence of multiple risk factors in fact generate in children and young people in foster care, important difficulties in development, which foster families have to cope with, also with the support of specialists, services and associations. However, the skills that caregivers come to build over the years are valuable, deserving of pedagogical insights, so that good practices of positive parenting can be valued and shared. In this paper we will report the results of a survey, carried out with a national sample of 323 foster families. The study makes it possible to investigate the reasons for the custody prevision, the relationships with families of origin, the difficult life trajectories of the children in foster care (transitions, placements, discontinuities, years of foster care, continuation of relationships after foster care). In this way it is possible to identify the needs highlighted by the minors, the relevant problems that emerge and the promising strategies adopted by the foster families.
... A robust body of evidence supports the efficacy of Triple P for strengthening children's social-emotional-behavioral outcomes, parenting practices, and parental wellbeing and adjustment. These results hold for each level of the Triple P system, and across diverse communities and multiple countries (Nowak & Heinrichs, 2008;Sanders et al., 2014). While no studies to date have assessed Triple P specifically for substance using families, it has been effective serving families with complex and diverse needs relevant to the central Ohio community, including mothers experiencing depression, children with and without disabilities, families living in homeless shelters, and in underserved rural communities when delivered in person or via telehealth (Goodman & Garber, 2017;Haskett et al., 2018;Nowak & Heinrichs, 2008;Reese et al., 2015). ...
Background
Many studies have examined the Positive Parenting Program (Triple P), yet few have considered its effectiveness during the twin challenges of the opioid crisis and COVID-19 pandemic.
Objective
This study examines the implementation of, and parenting outcomes associated with the Positive Parenting Program (Triple P) in 13 counties in central Ohio.
Participants and setting
The program was provided to parents who were at heightened risk for substance use. From July 2020 through June 2021, 890 parents received services from Triple P.
Methods
Parents completed pre- and post-test assessments of protective factors within their families and parenting behaviors. Parents also participated in qualitative interviews regarding their experiences in the program.
Conclusions
Overall, the results were promising, with improvements seen in family functioning/resilience, nurturing and attachment, parental laxness, and parental over-reactivity. Parents reported positive experiences participating in the program and felt that their relationship with their child had improved. Despite the profound, recent challenges to parenting and service provision, Triple P continues to show promise as an approach to reducing child maltreatment. Expansion of Triple P to other areas may improve parenting behaviors and reduce child maltreatment among parents at risk for substance use.
... In times of uncertainty, mothers with low levels of social support report higher levels of perceived stress (Ajdukovid et al., 2018). Conversely, supportive environments may mitigate the effects of external stressors on parental stress and are associated with more positive parenting (McConnell et al., 2011;Sanders et al., 2014). Perceived social support from families and peers has also been associated with lower rates of anxiety, particularly in mothers of young children (Chavis, 2016). ...
We used latent profile analysis on a longitudinal dataset to examine changes in maternal and child mental health during COVID-19 and factors that may protect against declines in mental health. Participants were 183 low-income mothers (M = 36 years) with young children (M = 5.31 years) in the City of Toronto with data collected prior to and during the pandemic in 2020. Mothers reported on their own stress, anxiety and depression and their children's emotional, conduct, hyperactivity, peer and prosocial problems at both timepoints. We found heterogeneity in mental health changes, with 5 distinct patterns of change for mothers and 4 distinct patterns of change for children during COVID-19. The majority (83%) of mothers experienced significant declines in at least one aspect of mental health. In contrast, the majority of children (65%) experienced either no change or improvements in mental health. Interestingly, patterns of change across these groups were not differentiated by demographic characteristics such as income, education and family composition. However, for mothers, a higher degree of satisfaction with social support was associated with membership in a profile with better mental health both prior to and during the pandemic. For children, having a stable history of early childhood education and care was associated with membership in a profile that showed improvements in mental health during the pandemic. We discuss how our results support the need for proactive and global interventions for at-risk families with raised mental health concerns, and the benefits that stable early childhood education and care may provide for young children.
... A systematic meta-analysis by Kaminski et al [7] revealed several parenting strategies to be especially effective, such as consistently responding to one's child and using "time out" as a disciplinary strategy, with active acquisition of parenting skills revealing significantly large effects. In addition, improving parenting practices has been shown to benefit the well-being and overall development of both parents and children [8]. ...
Background
Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems.
Objective
The aim of this paper is to illustrate the user-centered development of ParentCoach.
Methods
We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration.
Results
Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program.
Conclusions
This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach.
... Because parenting is a major determinant of child development and a relevant factor affecting many outcomes along the life course, it is usually a main target for preventive, early intervention, and treatment programs aimed to promote child well-being and development (Sanders & Turner, 2018). This is the case, for example, of Behavioral Parent Training (BTP) programs, widely developed over the years, such as Triple P (Sanders et al., 2014) or The Incredible Years (Pidano & Allen, 2015). Such programs require valid and reliable measures of parenting practices to select areas of parenting in which intervention is needed, and to rigorously evaluate expected changes. ...
Parenting practices are a central focus of many family preventive and treatment programs due to their influence on children’s well-being. Reliable measures of parenting practices are relevant not only for research purposes, but also for assessment, selection of intervention goals, and evaluation of expected changes in clinical practice. However, measurement of parenting practices has been a challenge for researchers and practitioners. The Parenting Practice Interview (PPI) has been developed to assess both positive and negative parenting dimensions and has been used in clinical contexts. The present study aimed to develop a Spanish adaptation of the PPI and to analyze its main psychometric properties. The sample consisted of 213 parents with substantiated reports or at risk for child maltreatment with significant problems in coping with their children’s behavioral problems, recruited from Child Welfare and Child Protection Services. Confirmatory factor analysis (CFA), measurement invariance (MI), convergent validity, and differences based on parents’ and children’s age and gender were analyzed. A four-factor model with 25 items (Appropriate Discipline, Verbal Praise and Incentives, Inconsistent Discipline, and Physical Punishment) met statistical requirements (RMSEA = 0.06, CFI = 0.92, TLI = 0.91) and showed adequate internal consistency and convergent validity. MI analyses allowed comparison across time and groups. Although more research is needed, the PPI-25’s psychometric properties are encouraging for its use with families with substantiated reports or at risk for child maltreatment in Spain.
... Interventions focusing on parenting skills outside the clinical setting (e.g., how to use clear and calm instructions, logical consequences for misbehaviour) have gained more attention and often target parents or parents with their children (Medlow et al., 2016, Tarver et al., 2014. For instance, the Positive Parenting Programme (Triple P; Sanders et al., 2014, Sanders et al., 2000 aims to prevent and offer treatment for children's behavioural and emotional problems. Moreover, the Strengthening Families Programme (SFP; Kumpfer & Magalhães, 2018, Kumpfer et al., 1996 focuses on prevention and intervention with children at risk of substance abuse and delinquency. ...
Research has identified parental personality and parenting behaviour as important contributors to healthy child development. However, indirect associations are largely unknown. The current study aimed to investigate the mediating role of parenting dimension relations between parental personality and adolescent mental health problems. The cross-sectional sample included 4258 German adolescents (48.7% male, 11–17 years) and one parent who participated in a national health survey (KiGGS Wave 2). The results underline and extend previous indications of direct associations between parental personality and their children’s mental health problems by highlighting the adverse role of neuroticism. Furthermore, new insights are added regarding the mediating roles of parenting dimensions (i.e., warmth, behavioural control, and psychological control). Future efforts and parent-focused prevention programmes should be extended by parental personality to identify maladaptive parenting behaviour and thus contribute to the development of their children’s mental health.
Background
Heightened familial stress and distress during the COVID-19 pandemic may lead to increased negative parenting practices, particularly for parents with substantial adverse childhood experiences (ACES).
Objective
To determine whether families' COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' ACEs.
Participants and setting
Participants were 267 parents of children ages 1.5–5 years recruited from five primary care sites across the United States.
Methods
Participants completed internet questionnaires including measures of demographics, parent ACES, negative parenting, parent mental health, and COVID-19 distress. We used regression analyses to test a moderated mediation model in which the relationship between COVID-19 distress and child emotional/behavioral problems is mediated by negative parenting, and both the direct and indirect effects of COVID-19 distress on child emotional/behavioral problems is moderated by parents' ACEs.
Results
Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems (indirect effect β = 0.07). Parents' ACEs moderated the associations between COVID-19 distress and both negative parenting and child emotional/behavioral problems, such that each relationship was stronger in the context of higher parental ACEs. The model accounted for 42% of the variance in child emotional/behavioral problems.
Conclusions
Findings have implications for managing risk and promoting well-being in young children during periods of significant stress and routine disruption. This study advances understanding of factors influencing negative outcomes in children during the pandemic's acute phase and may have implications for the development of targeted interventions to improve families' adjustment in the future.
Introduction: Girls can use their mothers emotional, informational and behavioral support to perform healthy behaviors due to their constant access to their mothers. This study aimed to evaluate the effect of role modeling and maternal support in the family to improve healthy behaviors and perceived Family Health Climate (FHC) in female students.
Methods: In this quasi-experimental study 261 female students (133 in intervention group and 128 in control group) and 223 mothers (109 intervention and 114 control) were selected, using cluster multi-stages sampling method and entered the study. Participants completed the FHC scale at three stages (Before intervention, immediately after the intervention and two month after intervention). A training programme which comprised 12 sessions for students and 6 sessions for their mothers using collaborative learning techniques and printed materials was conducted with the experimental group. Data were analyzed using SPSS20 via chi-square test, independent t-test, and Repeated Measures ANOVA at significance level of 0.05.
Results: Before the intervention, there was no significant difference between demographic variables and the score of FHC scale in both groups (p<0.05). Immediately and two months after the intervention, the experimental group (female students and their mothers) showed a significant increase in dimensions of FHC including FHC-NU and FHC-PA (their subscales) compared to the control group (p<0.05).
Conclusions: Educating and informing mothers about their role model defects for their children, especially girls, can make them more aware of health-oriented behaviors towards their children. Such findings reinforced the importance of focusing on actions to encourage a healthy lifestyle (healthy diet and physical activity) in students with a focus on role modeling and parental support, especially mothers.
Parenting styles play a critical role in child well-being, yet the neural bases of parenting behaviors remain nebulous. Understanding the neural processes associated with parenting styles can both clarify etiological mechanisms underlying parenting behaviors and point us toward new targets for intervention. A novel electrocortical biomarker called the observational reward positivity (oRewP) that occurs in response to observing another receive a reward has been linked to self-reported authoritarian parenting behavior. The current study sought to replicate associations between the oRewP and self-reported and observationally-coded parenting in a sample of mothers selected to be at elevated risk for problematic parenting. Self-reported authoritarian parenting was associated with observationally-coded problematic discipline, while no other self-reported parenting scales were associated with observationally-coded scores. We replicated the previously reported association between a blunted oRewP and increased self-reported authoritarian parenting. We additionally found that an attenuated oRewP was associated with greater permissive parenting, and that only the relationship with permissive parenting was conserved after adjusting for other parenting styles and other relevant covariates. We did not find significant associations between the oRewP and observationally-coded parenting. The current findings suggest that the neural process indexed by the oRewP are relevant to parenting behavior. Further research is needed to better understand the discrepancy between self-reported and observed parenting.
Objective: The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10-12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element. Methods/Design: In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills. Results: All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ total difficulties (standardized mean difference:-0.07; 95% CI:-0.30 to 0.16; p = 0.54). There were no subgroup effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Based on independent observation, mean adherence, quality and participant responsiveness scores indicated scope to improve fidelity. Conclusions: The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.
Zusammenfassung
Eine Krebserkrankung stellt nicht nur für die erkrankte Person eine Herausforderung dar, sondern kann auch mit psychosozialen Beeinträchtigungen der Angehörigen, insbesondere der Partner und Partnerinnen und der minderjährigen Kinder, einhergehen. Obwohl Studien zu langfristigen Auswirkungen einer Krebserkrankung auf Partner und Partnerinnen, die Partnerschaft und die kindliche Entwicklung noch selten sind, gibt es Hinweise für die Chronifizierung der psychischen Belastungen von Angehörigen und für Risiken der Entwicklung psychischer Störungen bei Kindern erkrankter Eltern. Darüber hinaus erhöht eine Verschlechterung der partnerschaftlichen Zufriedenheit auch das Trennungsrisiko.
In der psychoonkologischen Versorgung sollten daher nicht nur die psychosozialen Belastungen der Erkrankten, sondern auch die der Partner und Partnerinnen und die Auswirkungen auf die Partnerschaft berücksichtigt werden und entsprechende Angebote z. B. zur Erhöhung der partnerschaftlichen und sexuellen Zufriedenheit, der Kommunikation oder dem dyadischen Coping erfolgen. Auch Kinder sollten in der Versorgung als Angehörige betrachtet werden. Ein Fokussieren auf die kindlichen Belastungen sowie auf die Verbesserung der Eltern-Kind-Beziehung und des Erziehungsverhaltens kann Kindern bei der Bewältigung der elterlichen Erkrankung auch langfristig helfen. Somit sollte eine Krebserkrankung immer auf individueller, dyadischer und familiärer Ebene betrachtet werden und psychosoziale Versorgungsangebote sollten auf allen Ebenen erfolgen.
Many American children live lives filled with trauma. According to the National Child Traumatic Stress Initiative (2020), more than two thirds of children will experience some form of trauma by the age of 16, and 26% of children will be exposed to trauma by age 4 (Negrini I Trauma across the lifespan, 2016). Childhood trauma exposure is a significant public health crisis often resulting in psychological and physical health consequences across the life span. Yet every child is an individual. The residual effects of trauma appear to exist on a continuum. While many trauma-exposed children exhibit concerning symptoms, others with similar experiences appear relatively unscathed (Jaffee SR Dev Psychopathol 19:631–647, 2007). It is estimated that up to 15% of trauma-exposed children appear asymptomatic, whereas others develop life-altering symptoms or consequences (Werner E, Smith R Journeys from childhood to midlife: risk, resilience, and recovery. Cornell University Press, 2001). What is the explanation for this phenomenon? Resiliency has been suggested to explain this variation in pathology expression among trauma-exposed children (Hornor G, J Pediatr Health Care 31:384–390, 2017). This chapter will describe resilience in children experiencing trauma while exploring research and evidence-based interventions to enhance resilience in children who have experienced trauma.
Research indicates that healthy development of children and young people is directly related to the nature and quality of parenting/ caregiving they receive. Parenting support interventions have potential to support healthy child development and mental health. While many parenting programs, in controlled research settings, have demonstrated efficacy in improving child mental health outcomes, there are numerous challenges in translating these programs to real-world settings.
The aim of this review was to systematically identify and synthesise existing qualitative research on the barriers and facilitators that influence the implementation of parenting programs in real-world settings.
Four key electronic databases (PsycInfo, Medline, Family and Society Studies Worldwide and CINAHL) were searched. A modified population, intervention, control, and outcome (PICO) inclusion/ exclusion criteria framework determined the inclusion of fourteen articles in the review. All identified studies were double-screened, and data were extracted independently by two authors. Included studies were synthesised using framework synthesis methods and were quality appraised.
The results from the synthesis revealed six themes and sixteen subthemes related to implementation barriers and facilitators. The overarching themes were: system level factors, provider characteristics, program characteristics, organisational characteristics, prevention support system factors, and client factors. Provider, program, and organisational characteristics were the most frequently reported.
The findings highlight the importance of considering these factors from the initial stages of development and implementation of parenting programs into real-world settings.
Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff “buy-in”, designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.
Background
Parent-only interventions for childhood anxiety may be an important alternative to resource and time intensive child-focused cognitive behavioural therapy (CBT). This systematic review and meta-analysis aimed to investigate the efficacy of parent-only interventions in reducing symptoms of anxiety disorders in school-aged children.
Methods
A systematic search of five databases (inception to March 2021) identified 29 eligible studies. A range of study designs were captured, including randomised controlled trials (RCTs) and case series. A narrative synthesis was conducted. Random effects meta-analyses were performed on parent- and child-reported outcomes and pre-test post-test effect sizes were calculated for uncontrolled studies.
Results
Findings indicated a significant treatment effect for parent-only interventions compared to waitlist controls. No significant differences were found when comparing parent-only interventions with other active interventions; anxiety symptoms reduced in both conditions. No significant treatment effects were found for child-rated outcomes. Calculated effect sizes for uncontrolled studies were typically large, although sample sizes were small. No clear evidence was found for a superior type, duration or format of intervention.
Limitations
The methodological quality of many studies in this review (19/29) was rated ‘weak’. Only English language papers were included.
Conclusions
To date, this is the first systematic review and meta-analysis of the efficacy of parent-only interventions for reducing symptoms of child anxiety disorders. Our results suggest that parent-only interventions may be effective in reducing child anxiety. These findings are important for clinical practice because they suggest that efficient, low intensity interventions delivered to parents may lead to positive outcomes for children.
Perspectives of parents themselves should be central in framing services delivered to families experiencing homelessness. We explored the strengths and positive features of mother–child relationships and insight into mothers' views of the impact of living in shelters. We conducted qualitative coding of the Five‐Minute Speech Sample (FMSS) of 41 mothers of young children. Results revealed a wide variety of strategies that mothers used to promote their children's resilient functioning. This included focusing on their children's strengths, providing unconditional love and engaging in positive activities together. Mothers also voiced varied approaches to parenting, including many positive practices. Mothers' FMSS included ways that living in the shelter had a negative impact on their child's functioning, and they reported negative changes in their relationship with their child since moving into the shelter. Finally, mothers discussed ways in which living in the shelter had influenced their parenting styles and approaches to discipline. We discuss implications of the findings for supporting families residing in shelters, and we provide recommendations for further research.
This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers’ and children’s level of functioning as well as the children’s internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children’s Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.
Background
Systematic reviews have shown attachment-based parenting programs to lead to improvements in parenting sensitivity and infant attachment, but none have focused specifically on the impact of attachment-based parenting programs on externalizing symptoms in young children.Objective
The objective of this study was to review published randomized controlled trial evidence regarding the impact of attachment-based early parenting interventions on externalizing behaviors in children aged 1–5 years.MethodsA systematic search of published literature available through to May 2020 was conducted. Seven published papers reporting results from trials testing six attachment-based parenting interventions were identified.ResultsThree of the seven programs were shown to be associated with statistically significant improvements in child externalizing behavior (Helping Encourage Affect Regulation, Child-Parent Psychotherapy, Parent–Child Interaction Therapy—Toddlers). For one program (Child-Parent Psychotherapy), there was also evidence in one study that improvements in child externalizing behaviors were sustained at 6-month follow-up. A number of methodological limitations were present among the studies identified, most commonly reliance on parent-report measures of externalizing behavior.Conclusions
Taken together, results indicate that parenting interventions designed to promote secure parent–child attachment relationships may be effective in reducing externalizing behaviors in children aged 1–5 years of age. Further research is required to test programs in different populations and with longer follow-up times.
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 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 (NationalResearch 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 Munoz 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.
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.
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.
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.
This longitudinal study of forty-four families explored fathers’ as compared to mothers’ specific contribution to their children's attachment representation at ages 6, 10, and 16 years. In toddlerhood, fathers’ and mothers’ play sensitivity was evaluated with a new assessment, the sensitive and challenging interactive play scale (SCIP). Fathers’ SCIP scores were predicted by fathers’ caregiving quality during the first year, were highly consistent across 4 years, and were closely linked to the fathers’ own internal working model of attachment. Qualities of attachment as assessed in the Strange Situation to both parents were antecedents for children's attachment security in the Separation Anxiety Test at age 6. Fathers’ play sensitivity and infant–mother quality of attachment predicted children's internal working model of attachment at age 10, but not vice versa. Dimensions of adolescents’ attachment representations were predicted by fathers’ play sensitivity only. The results confirmed our main assumption that fathers’ play sensitivity is a better predictor of the child's long-term attachment representation than the early infant–father security of attachment. The ecological validity of measuring fathers’ sensitive and challenging interactive play behavior as compared to infant proximity seeking in times of distress is highlighted. Findings are discussed with respect to a wider view on attachment in that both parents shape their children's psychological security but each in his or her unique way.
Recent studies suggest that the reported effect sizes of prevention and intervention trials in criminology are considerably
larger when program developers are involved in a study than when trials are conducted by independent researchers. This paper
examines the possibility that these differences may be due to systematic bias related to conflict of interest. A review of
the evidence shows that the possibility of a substantial problem cannot be currently rejected. Based on a theoretical model
about how conflict of interest may influence research findings, the paper proposes several strategies to examine empirically
the extent of systematic bias related to conflict of interest. It also suggests that, in addition to improved standards for
conducting and publishing future experimental studies, more research is needed on the extent of systematic bias in the existing
body of literature.
We conducted a review and meta-analyses of 24 studies to evaluate and compare the outcomes of two widely disseminated parenting
interventions—Parent-Child Interaction Therapy and Triple P-Positive Parenting Program. Participants in all studies were caregivers
and 3- to 12-year-old children. In general, our analyses revealed positive effects of both interventions, but effects varied
depending on intervention length, components, and source of outcome data. Both interventions reduced parent-reported child
behavior and parenting problems. The effect sizes for PCIT were large when outcomes of child and parent behaviors were assessed
with parent-report, with the exclusion of Abbreviated PCIT, which had moderate effect sizes. All forms of Triple P had moderate
to large effects when outcomes were parent-reported child behaviors and parenting, with the exception of Media Triple P, which
had small effects. PCIT and an enhanced version of Triple P were associated with improvements in observed child behaviors.
These findings provide information about the relative efficacy of two programs that have received substantial funding in the
USA and Australia, and findings should assist in making decisions about allocations of funding and dissemination of these
parenting interventions in the future.
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.