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Studies on the efficacy of parent training programs have mostly been conducted with preadolescents, with only a few studies investigating family treatment models in adolescents. In this article, a study is described that evaluates Standard Teen Triple P (Positive Parenting Program), a behavioural family intervention for parents of 11- to 16-year-old teenagers. Participants were 46 families with a teenager who was experiencing detectable behavioural and emotional problems. Compared to parents in the waitlist control condition, parents participating in the intervention condition reported decreased levels of teen disruptive behaviours and parent adolescent conflict, as well as a reduction in the use of ineffective parenting strategies and conflict over child-rearing issues. These positive changes were maintained at the 3-month follow-up. Results suggest that Standard Teen Triple P is a promising parenting intervention for tackling adolescent externalising problems.
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An Efficacy Trial: Positive Parenting
Program for Parents of Teenagers
Raziye Salari, Alan Ralph, and Matthew R. Sanders
The University of Queensland, Brisbane, Queensland, Australia
Studies on the efficacy of parent training programs have mostly been conducted
with preadolescents, with only a few studies investigating family treatment models
in adolescents. In this article, a study is described that evaluates Standard Teen
Triple P (Positive Parenting Program), a behavioural family intervention for parents
of 11- to 16-year-old teenagers. Participants were 46 families with a teenager who
was experiencing detectable behavioural and emotional problems. Compared to
parents in the waitlist control condition, parents participating in the intervention
condition reported decreased levels of teen disruptive behaviours and parent ado-
lescent conflict, as well as a reduction in the use of ineffective parenting strategies
and conflict over child-rearing issues. These positive changes were maintained at
the 3-month follow-up. Results suggest that Standard Teen Triple P is a promising
parenting intervention for tackling adolescent externalising problems.
!Keywords: parenting programs, adolescent problem behaviours
Adolescence is a period of enormous adjustment for both teenagers and families. As
children transition from childhood to adulthood, they go through many physical, emo-
tional and behavioural changes. Not surprisingly, many parents describe adolescence
as the most difficult and anxiety-provoking period of their children’s life (Buchanan
et al., 1990). Parents’ concerns are well justified, considering the high prevalence of
emotional and behavioural problems during adolescence (Costello, Mustillo, Erkanli,
Keeler, & Angold, 2003). This highlights the importance of prevention and treat-
ment efforts to address emotional and behavioural problems during this developmental
stage.
Family risk factors such as inadequate parental monitoring and family conflict are
among potentially modifiable risk factors that can be targeted in order to reduce the
rate of emotional and behavioural problems in adolescents (Dekovic, Janssens, &
Van As, 2003). Although studies on parenting programs for parents of teenagers are
far less extensive compared to studies of children (Kazdin, 2005), they show parent
training programs to be effective prevention and intervention strategies to promote
positive development in adolescents. These programs reduce the risk of developing and
maintaining substance abuse, delinquent behaviour and other externalising problems
(Connell, Dishion, Yasui, & Kavanagh, 2007; Mason, Kosterman, Hawkins, Haggerty,
& Spoth, 2003). They also improve parent-adolescent communication and reduce
family conflict (Barkley, Edwards, Laneri, Fletcher, & Metevia, 2001; Dishion &
Andrews, 1995). Participating parents feel more confident and use more effective
parenting strategies (Spoth, Redmond, & Shin, 1998). In several studies, these positive
Address for correspondence: Alan Ralph, Parenting and Family Support Centre, School of Psychology, The
University of Queensland, Brisbane QLD 4072, Australia. Email: ralph@triplep.net
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Behaviour Change Vol um e 31 Number 12014 pp. 34–52 c
The Author(s), published by Cambridge
University Press on behalf of Australian Academic Press Pty Ltd 2014 doi 10.1017/bec.2013.31
Standard Teen Triple P
changes are maintained over time; in some examples, up to 4 to 10 years (Spoth,
Trudeau, Shin, & Redmond, 2008).
Most parenting programs for parents of teenagers have been designed and evaluated
either as universal and selective prevention strategies (e.g., Preparing for the Drug-Free
Years; Hawkins, Catalano, & Kent, 1991) or as part of a treatment package for severely
disturbed juvenile delinquents (e.g., Multisystemic Therapy; Henggeler, Schoenwald,
Borduin, Rowland, & Cunningham, 2009). There is limited evidence on the efficacy
of parenting programs for adolescents who are currently showing serious difficulties,
but have not come in contact with the justice system. Moreover, most programs
are delivered in group formats, which may not be suitable for some families. Some
parents might refuse treatment in a group format because of the anxiety about sharing
problems with others, social anxiety or lack of personal attention. Parents who are not
able or willing to examine their interpersonal behaviours, to disclose themselves, and
to give and receive feedback are not suitable for brief and time-limited group programs
(Yalom & Leszcz, 2005). Other parents may find the group format inconvenient for
practical reasons. Due to unpredictable working hours, certain parents may not be
able to commit to a regular schedule of sessions as required for group programs. There
may also be logistical problems in setting up groups, and parents may have to wait for
treatment until there are a sufficient number of parents to begin a group.
The current study is an evaluation of Standard Teen Triple P (STTP). Triple P
is a multi-level behavioural family intervention, based on social learning principles
(e.g., Patterson, 1982), which aims to prevent and treat behavioural, emotional and
developmental problems in children and adolescents by enhancing the knowledge,
skills and confidence of parents (Sanders, 1999). Teen Triple P is specifically designed
to meet the needs of parents of adolescents. The self-directed and group versions
of this program have already been evaluated and found to be effective in reducing
parent-adolescent conflict, dysfunctional parenting (laxness, over-reactivity) and dis-
agreements over parenting issues, as well as adolescent behavioural problems (Ralph &
Sanders, 2003; Stallman & Ralph, 2007). STTP is an individual face-to-face version
of Teen Triple P.
The purpose of this study was to trial the efficacy of STTP. Specifically, it was
hypothesised that compared to parents in a waitlist control condition, parents who
received STTP would report: (a) decreased disruptive problem behaviours in their
teenagers; (b) decreased levels of parent-teenager conflict; (c) decreased use of dys-
functional parenting practices; (d) decreased level of disagreements over child rearing
issues; (e) increased level of relationship satisfaction; and (f) decreased levels of neg-
ative affect (e.g., anxiety, depression).
Method
Recruitment
Participants were recruited through school newsletter advertisements in the Brisbane
area, Australia, from April 2007 to August 2008. The notice targeted parents of
teenagers (‘Are you concerned about your teenager’s behaviour?’), offering them a free
individual parenting program. Interested families were directed to visit a website or
contact the project coordinator for more information. The intervention was delivered
at either the Parenting and Family Support Centre or the Psychology Clinic at The
University of Queensland.
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Raziye Salari, Alan Ralph and Matthew R. Sanders
Atwo-stageapproachwasemployedtoassessfamilies’eligibilitytoparticipatein
the study. In the first stage, a short standardised telephone interview by the author
was used to assess families’ suitability for the program and also to inform parents of the
program details and participation requirements. Families were eligible to participate
if: (a) the target child was aged between 11 and 16 years of age, (b) at least one
parent reported that they were concerned about their child’s behaviour, and (c) the
child was not currently having regular contact with another professional or agency
for emotional or behavioural problems. Families were excluded from the project if
the target child did not live with the interested parent for at least 2 days each
week, or there was evidence of a severe developmental disorder or significant health
impairment. If the eligibility criteria were met, the parent(s) were sent the package
of questionnaires or were directed to complete them online, depending on their
preference. Before completing the questionnaires, parents were requested to read
the information sheet and consent to participating in the research, which included
being videotaped during the sessions. In the second stage, parents’ responses to the
questionnaires were examined. For inclusion in the study, the target child was required
to score in the elevated range (i.e., borderline or abnormal range) on the parent version
of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997, 1999). When
both parents completed the questionnaires, the family was considered eligible if at
least one of the parents indicated that the target child scored in the elevated range on
the SDQ.
Participants
Figure 1 shows the flow of participants throughout the study. A total of 300 parents
responded to the campaign, contacting the project coordinator by email (87) or phone
(213). Ninety families were excluded from the study because they did not meet the
eligibility criteria (i.e., 13 children were not in the age range, 53 parents were not
concerned about their child’s behaviour, 4 children were in contact with another
mental health professional on a regular basis, 15 parents were unable to attend the
program because of the location or length of the program, 3 children lived with the
interested parents less than 2 days a week, and 2 children had a severe developmental
disorder). A further 65 parents declined to participate. Contact was not possible with
seven parents. Therefore, 138 families received the questionnaires by post (86) or
were provided with online access to the questionnaires (52). Eighty families (60%)
returned the questionnaires. Of these, 18 families (22.5%) were excluded because
neither parent reported serious problem behaviours in the child (the target child did
not score in the borderline or clinical range on the SDQ Total; borderline range =
14 to 16 and clinical range =17 and over). The remaining 62 families were allocated
to one of the two conditions.
Comparison of the waitlist and intervention conditions using a series of one-
way between groups analyses of variance (ANOVAs) or chi-square tests revealed
no significant differences on sociodemographic variables except for child sex. Only
30.3% of adolescents in the intervention condition were females, compared to 62.1%
of adolescents in the waitlist control condition χ2(1, N=62) =6.29, p=.012. In
the total sample, children ranged in age from 11 to 16 years (M=12.92, SD =1.18),
and there were more boys (54.8%) than girls (45.2%). Based on parents’ reports, the
children were predominantly identified as Australians or Europeans (93.5%). Parents
who initiated the contact were mainly mothers (91.9%) aged between 27 and 52
36
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Standard Teen Triple P
EnrolmentRandomizationAnalysisPost
assessment
Analysis3 month
follow up
Analysis
300 contacts
162 excluded/rejected:
90 did not meet criteria
72 declined to participate
138 sent the questionnaires
80 completed PRE assessment
58 dropped out
62 allocated
18 not eligible
29 allocated to waitlist control 33 allocated to intervention
26 completed POST assessment
3 dropped out
26 analysed
21 completed POST assessment
19 completed intervention
2 discontinued intervention
5 failed to start
3 dropped out
20 analysed
3 dropped out
17 completed FU assessment
17 analysed
1 excluded
attended 2 sessions only
29 entered and analysed
4 excluded
2 psychotic symptoms
2 withdrew the consent
29 entered and analysed
FIGURE 1
Flow of participants throughout the study (see Results section for attrition reasons).
years (M=42.08, SD =5.12). Most families were two-parent families (75.8%), with
an average of two children living at home (M=2.45, SD =1.14). The majority of
parents had some type of tertiary education (75.8% of mothers and 79.2% of fathers)
and were employed outside the home (80.6% of mothers and 97.9% of fathers). More
than half of the families (53.1%) had an annual income of more than AUD$75,000.
Behaviour Change
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Raziye Salari, Alan Ralph and Matthew R. Sanders
Measures
Teenager problem behaviour.Parents’ perception of prosocial and difficult behaviours
in their teenagers was assessed using the Strengths and Difficulties Questionnaire —
extended Version (SDQ; Goodman, 1997, 1999). The SDQ is a behavioural screening
questionnaire for children aged from 3 to 16 years. It consists of 25 statements with
five subscales (Pro-social, Hyperactivity, Peer problems, Emotional symptoms and
Conduct problems). Each item is rated on a 3-point scale from 0 (not true) to 2
(certainly true). The extended version assesses whether the respondent thinks the
child has a problem, and if so, the perceived impact on the child and burden on the
family. The SDQ has good internal consistency, test–retest reliability and discriminant
validity (Goodman, 2001; Goodman & Scott, 1999).
Conflict with teenager.Perceived communication and conflict in the parent-
adolescent relationship was assessed using the short version of the Conflict Behavior
Questionnaire (CBQ-20; Robin & Foster, 1989). Parents were asked to indicate
whether each statement is true or false. The CBQ has been found to successfully
discriminate between distressed and non-distressed families. The 20-item CBQ has a
correlation of .96 with the 75-item scale which has adequate validity and reliability
(Robin & Foster, 1989).
Parenting style.Parenting Scale — Adolescent version (PSA; Irvine, Biglan,
Smolkowski, & Ary, 1999) is an adaptation of the Parenting Scale (Arnold, O’Leary,
Wolff, & Acker, 1993) and retains 13 items from the original 30. The scale measures
two dysfunctional discipline styles in parents: Laxness (permissive discipline) and
Over-reactivity (authoritarian discipline). For each item, parents are asked to rate
how they would react to a given behaviour problem by choosing between an effective
or ineffective strategy on a 7-point scale. The revised scale has adequate internal
consistency for the Total score (α=.84), Laxness (α=.82), and Over-reactivity
(α=.83) scales as well as good test–retest reliability (r =.86, .82, and .82 respec-
tively; Irvine et al., 1999). The scale has been found to discriminate between parents
of clinic and non-clinic children.
Conflict over parenting.The Parent Problem Checklist (PPC), by Dadds and Powell
(1991), is a 16-item questionnaire that measures interparental conflict over child
rearing. It rates parents’ ability to cooperate and work together in family management
including the extent to which parents disagree over rules and discipline for child
misbehaviour, the amount of open conflict over child-rearing issues, and the extent
to which parents undermine each other’s relationship with their children. The PPC
has moderately high internal consistency (α=.70) and high test–retest reliability
(r=.90; Dadds & Powell, 1991).
Relationship satisfaction.Parents’ relationship satisfaction was measured using the
Relationship Quality Index (RQI; Norton, 1983). The RQI is a six-item index of mar-
ital or relationship quality and satisfaction. It has adequate internal consistency; with
inter-item correlations ranging from .68 to .86 (Norton, 1983), excellent reliability
(α=.97) and discriminant validity (Heyman, Sayers, & Bellack, 1994).
Parental adjustment.Parents’ adjustment was assessed using the Depression Anxiety
Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). This is a 21-item question-
naire assessing symptoms of depression, anxiety, and stress in adults. Each item is rated
on a 4-point scale from 0 (did not apply to me)to3(applied to me very much, or most
38
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Standard Teen Triple P
of the time). The DASS-21 has high internal consistency for each of the depression,
anxiety, and stress scales (α=.91, .84 and .90, respectively) and good discriminant
and concurrent validity (Antony, Bieling, Cox, Enns, & Swinson, 1998; Henry &
Crawford, 2005).
Client satisfaction.The Client Satisfaction Questionnaire (CSQ; Sanders & Ralph,
2002) addresses the quality of service provided; how well the program met the parents’
needs, increased the parents’ skills, and decreased the child’s problem behaviours;
and whether the parent would recommend the program to others. The scale has
high internal consistency (α=.96), an item-total correlation of .66 and inter-item
correlations of .30 to .87 (Sanders, Markie-Dadds, Tully, & Bor, 2000).
Design
In this study, a quasi-randomised group comparison design was used with two con-
ditions: waitlist control and intervention; and two time periods: pre-intervention
(PRE) and post-intervention (POST). Families in the intervention condition were
also assessed at 3 months post-intervention (FU).
Procedure
Randomisation and allocation.Using standard methods of randomisation was not
practical in this study. When the study started in April 2007, response to the recruit-
ment was slow. Interns who were trained to deliver the intervention were finishing
their internship at the end of year and were unable to start working with families later
than August. Therefore, it was decided to assign all eligible families recruited until the
end of August to the intervention condition and allocate eligible families recruited
after this period to the waitlist condition. This would allow enough time to recruit
and train new interns to continue the program.
The recruitment was recessed during December 2007 to May 2008 and the program
was not advertised actively during this time because there were not enough qualified
practitioners to take on new families. Despite this, families who initiated contact
during this time were assessed for their eligibility criteria and if eligible were assigned
to the waitlist control condition. The recruitment started again in June 2008. In this
round, the eligible families were randomly allocated to each condition at point of
entry. A series of one-way between groups analyses of variance (ANOVAs) or chi-
square tests revealed no differences on sociodemographic variables for the families
recruited in the first and second round.
Assessment.All families completed the initial assessment (PRE) as part of the re-
quirements of participating in STTP. Parents were given the option to either receive
ahardcopyofthequestionnairesviapostorcompleteanonlineversion.Theparent
who agreed to attend the program was asked to complete the assessment. The second
parent (when applicable) was given the opportunity to complete the questionnaires
and attend the intervention, if interested. Identical assessments were carried out at the
subsequent times (i.e., POST, FU). The post-assessment data for the waitlist control
group were collected 3 months after the initial assessment. These families were then
offered the intervention.
Data collection was undertaken with the approval of The University of Queensland
School of Psychology Ethics Review Officer.
Behaviour Change
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Raziye Salari, Alan Ralph and Matthew R. Sanders
Intervention
Session structure.STTP is a 10-session program that provides parents with informa-
tion and practical strategies to promote healthy development and manage problem
behaviours in their teenagers. Both parents (where applicable) are invited to attend
the sessions. Teenagers are encouraged to attend some of the sessions (sessions 2, 5, 7
and 9), though their attendance is not necessary. Sessions are delivered individually
and can last up to 90 minutes. Active skill training methods are utilised to help parents
learn new knowledge and skills. These methods include video demonstration, mod-
elling, behavioural rehearsal, feedback, and homework tasks. Each family receives a
workbook that contains all of the information and strategies presented in the sessions,
as well as homework to be completed between sessions. A self-regulatory framework
is employed throughout the program; parents are encouraged to set their own goals
for change and monitor their progress.
Session content.STTP involves five modules, comprising three sessions for assess-
ment, two sessions on positive parenting skills, two sessions on managing problem
behaviours, two sessions on dealing with risky behaviour, and a closure session. In the
first session, parents are interviewed to obtain information regarding the presenting
problem, the teenager’s developmental history and family history. The teenager is
invited to attend the second session for a short interview. During this session, a task is
set up to observe a parent-teenager interaction. In the third session, the practitioner
shares the assessment results and introduces the possible influences on teenagers’ be-
haviour. To help parents achieve their goals, a range of strategies is presented and
practised during the next six sessions. Each session of active training (sessions 4, 6,
and 8) is followed by a practice session, where both parents and the teenager are
encouraged to attend in order to provide parents with an opportunity to practise
using the strategies learnt in the previous session. If the teenager refuses to attend,
parents report on how they used the strategies at home. They are then encouraged
to practise using the strategies through role-play. In both scenarios, parents receive
some feedback from the practitioner, refine their goals and revise their parenting plan
accordingly. The final session covers additional skills to facilitate generalisation and
maintenance of treatment gains.
Intervention delivery.Twenty-three postgraduate students in psychology (21 females,
two males) conducted the intervention, each working with two families on average.
All practitioners were trained in STTP and received clinical supervision for delivering
the intervention from an experienced clinical psychologist (preliminarily from the first
author of the STTP materials). Families were assigned to practitioners on the basis
of scheduling needs (e.g., case flow) in each condition. All practitioners received a
detailed written manual that specifies the content of each session, in-session exercises
to complete, and homework tasks to be assigned.
Data Analysis
The efficacy of the intervention was analysed using both the statistical and clinical
significance of change. Short-term intervention effects were tested using a series of 2
(condition: STTP, waitlist) ×2 (time: PRE vs. POST) repeated measures ANOVAs
(for individual scale comparison) or MANOVAs (for measures having multiple sub-
scales). Where a significant interaction occurred between condition and time, time
effects were examined within each condition using one-way repeated measures (PRE
40
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Standard Teen Triple P
vs. POST) ANOVAs and MANOVAs. Maintenance of short-term intervention ef-
fects was analysed using a series of one-way (time) repeated measures (PRE vs. FU)
ANOVAs or MANOVAs in the intervention condition. The clinical significance of
change from PRE to POST was estimated by the reliable change index (Jacobson &
Truax, 1991).
The final test was a series of supplementary analyses. An intention to treat analysis
was performed to account for participant attrition. Missing data were imputed using
the last-value-carried-forward method (Kendall, Flannery-Schroeder, & Ford, 1999).
Results
When both parents (in two-parent families) had completed the assessment, the data
for the parent who had initiated the contact was used in data analysis regardless of their
SDQ score. Twelve mothers (eight of them in the intervention) who had initiated
the contact, scored in the normal range of the SDQ Total while their partner (teen’s
father or stepfather) scored in the elevated range. Nevertheless, the mothers’ scores
were used in the data analysis. This is a conservative approach that reduces the chance
of finding significant results, as participants who are in the normal range to begin with
do not have much room to change.
Preliminary Analysis
Adequate randomisation.Aseriesofone-way(condition)betweengroups(interven-
tion vs. waitlist) ANOVAs and MANOVAs was performed to check for differences
between the two conditions in child and family functioning at pre-assessment. Only
two significant differences were observed: compared to parents in the intervention
condition, parents in the waitlist condition reported a lower level of burden on their
family due to their teenager’s difficulties on the SDQ, F(1,60) =7.45, p<.05; and a
higher level of laxness on PS, F(1,60) =7.25, p<.05. Given the number of analyses
performed, it is possible that these findings were due to chance. Nevertheless, any
differences at pre-intervention were controlled by using repeated measures ANOVAs
and MANOVAs for analysing the data.
Attrition.Two families who had been assigned to the intervention condition were
excluded from the study due to subsequent evidence of psychotic symptoms in the
target child; they were referred for appropriate clinical services outside of the study
setting. Another two families withdrew the consent for the sessions to be videotaped
and consequently were no longer eligible to participate in the study. These four
families were excluded from all subsequent analyses, including comparison of families
with and without post-assessment data and intention to treat analysis. Therefore, the
sample size for the intervention condition was reduced to 29.
From 29 families in the intervention condition, five families failed to start the
intervention (17.2%). Reasons for withdrawal were a lack of time (n=4) and seeking
individual help for the teenager’s behaviour where the teenager attended the interven-
tion instead of the parents (n=1). Of 24 families who started the intervention, two
families dropped out after the first session without completing the post-assessment and
another family completed the program, but did not return the post-questionnaires.
Therefore, post-assessment data were available for 21 families. Of these, 19 fami-
lies completed the intervention and 2 did not; one family had a teenager with ex-
treme difficulties and decided to take her for individual treatment where she was the
Behaviour Change
41
Raziye Salari, Alan Ralph and Matthew R. Sanders
direct target of the intervention, and in the other family, the teenager moved out of
home. The first family had completed session 5 of the program before dropping out
and thus was considered to have been exposed to active elements of the intervention
and was included in the analyses. The second family had attended only two sessions
(assessment sessions) and as such was excluded from the analyses. The rate of attrition
from pre- to post-assessment was 27.6% (8 out of 29). The intervention attrition rate
(families who did not complete the program) was 31% (9 out of 29) for the total group
and 16.7% (4 out of 24) for families who started the intervention.
Aseriesofone-wayANOVAsandMANOVAsandchi-squaretestswasusedto
compare completers versus non-completers across all sociodemographic characteris-
tics, and child and family functioning. The family that had attended five sessions of
the intervention and was included in the analysis of the intervention effects, was con-
sidered as a completer here. There were three significant differences between families
who completed and families who did not complete the intervention. Both mothers and
fathers in the families who did not complete the intervention were less likely to have
some kind of tertiary education compared to those who completed the intervention;
χ2(1, N=29) =4.49, p=.034 for mother’s education (55.6% of non-completers vs.
90% of completers) and χ2(1, N=24) =4.89, p=.027 for father’s education (57.1%
of non-completers vs. 94.1% of completers). Furthermore, mothers who did not com-
plete the intervention were significantly younger than mothers who completed the
intervention; F(1, 29) =4.66, p=.040 (M=38.56 vs. M=43.25). There were no
other significant differences between the two groups.
In the waitlist control condition, three of the 29 families did not complete the
post assessment (10.3%). In one family, the teenager had moved out and the other
two families provided no reason for not completing the questionnaires. A chi-square
test demonstrated no significant differences in attrition rate between the intervention
and waitlist control conditions. From pre- to post-assessment, the overall attrition
rate (for both the intervention and the waitlist control condition) was 19%. A series
of one-way (attrition) between groups (POST completed vs. POST not completed)
ANOVAs and MANOVAs and chi-square tests demonstrated no significant differ-
ences in the sociodemographic characteristics and child and family functioning of
families who completed and did not complete post assessment. The attrition rate from
pre-assessment to follow-up (for the intervention condition only) was 34.6% (families
who withdrew from the study were not invited to subsequent assessments).
Intervention Quality
Client satisfaction.Satisfaction with the program is reported for all families who
participated in the program and completed the Client Satisfaction Questionnaire,
even if they did not complete the program (n=21). Parents who participated in the
intervention reported high levels of satisfaction with the program and the amount of
help they received; 95.2% being satisfied to very satisfied. All parents (100%) rated
the quality of the service they received as good to excellent. The majority of parents
reported that the program had met most of their teenager’s needs (61.9%), and their
own needs (81%). Most parents (90.5%) stated the program had helped them to deal
more effectively both with problems that arose in their family and with the teenager’s
behaviours; 90.5% reported improvements in their teenager’s behaviour, and 76.2%
said they were satisfied with their teenager’s progress.
42
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Standard Teen Triple P
Protocol adherence.Session Summary Checklists (SSC) list the key content areas that
should be covered in each session (e.g., ‘Outline the purpose of discussing influences
on teenagers’ behaviour’, ‘Explain tasks to be completed between sessions’). It was
developed to guide practitioners in delivering the intervention and also to check
protocol adherence. Practitioners completed the checklists after conducting each
session. Analyses of the SSC indicated 97.8% self-reported compliance to the program
content.
Short-Term Intervention Effects
The results of the two-way (condition by time) and one-way (time) repeated measures,
(PRE vs. POST) ANOVAs and MANOVAs on adolescent and parent outcomes are
described below. Table 1 shows means, standard deviations, Fvalues, levels of signifi-
cance, effect sizes and their 95% confidence intervals for the univariate condition by
time interaction.
Adolescent outcomes.From pre- to post-assessment for the SDQ Total score, the two-
way ANOVA revealed a significant condition by time interaction, F(1, 44) =4.42,
P=.041. In the one-way ANOVA for the SDQ Total, there was a significant time
effect for the intervention condition only, F(1, 19) =19.74, p<.001. Therefore,
an overall reduction in teen problem behaviours was observed for the intervention
group, but not for the waitlist control condition. The effect size for teen overall
problem behaviours was medium (d=.62).
From pre- to post-assessment for all the SDQ subscales, the MANOVA revealed
asignicantconditionbytimeinteraction,F(1, 44) =4.42, p=.043. However,
the univariate condition by time interaction was only significant at the Bonferroni-
corrected level of significance (p<.01) for the Conduct Problems and Hyperactivity
scales, F(1, 44) =8.27, p=.006, and F(1, 44) =8.07, p=.007, respectively. The
univariate condition by time interaction for all other three subscales of the SDQ
was non-significant. In the one-way MANOVAs, there was a significant multivariate
time effect for the intervention condition only, F(1, 19) =18.08, p<.001. In the
intervention condition, the univariate time effect was significant for both Conduct
Problems, F(1, 19) =14.98, p=.001; and Hyperactivity, F(1, 19) =27.58, p=.001.
This indicates that from pre- to post-assessment, behavioural problems remained stable
in the waitlist condition, but decreased significantly in the intervention condition.
These changes were associated with large effect sizes (d>.80). There was no significant
change in the social or emotional problems.
For the SDQ impact supplement measures, the MANOVA revealed a significant
condition by time interaction, F(1, 44) =6.54, p=.003. The univariate condition by
time interaction was significant at the Bonferroni-corrected level of significance (p<
.025) for both the SDQ Impact, F(1, 44) =8.83, p=.005; and the SDQ Burden, F(1,
44) =10.13 p=.003. In the one-way MANOVAs there was a significant multivariate
time effect for both the intervention and waitlist control condition, F(1, 19) =18.04,
p<.001, and F(1, 25) =4.07, p=.03, respectively. However, the univariate time
effect for the SDQ Impact and the SDQ Burden was significant at the Bonferroni-
corrected level of significance (p<.025) for the intervention condition only; F(1,
19) =12.25 p=.002; and F(1, 19) =38.00, p<.001, respectively. As shown in
Table 1, while in the intervention condition both the SDQ Impact and the SDQ
Burden decreased from pre- to post-assessment, in the waitlist control condition there
was an increase in the SDQ Impact and a reduction in the SDQ Burden. This result
Behaviour Change
43
Raziye Salari, Alan Ralph and Matthew R. Sanders
TABL E 1
Short-Term Intervention Effects: Descriptive Statistics,
F
values and Effect Sizes for the Univariate Condition by Time Interactions
Waitlist Control (
n
=26)aIntervention (
n
=20)bPRE to POST time effect
95% confidence
PRE POST PRE POST intervals for d
Measure
M
(
SD
)
M
(
SD
)
M
(
SD
)
M
(
SD
)
FP d
Lower Higher
SDQ Total Difficulties 17.50 (4.59) 15.65 (6.21) 16.90 (6.58) 11.85 (8.28) 4.42 .041 .62 .03 1.22
SDQ Emotional Symptoms 3.96 (2.63) 3.08 (2.70) 3.10 (2.59) 2.35 (2.50) .03 .860 .05 .63 .53
SDQ Conduct Problems 5.07 (1.47) 4.50 (2.10) 5.15 (2.39) 2.85 (2.35) 8.28 .006 .82 .21 1.42
SDQ Hyperactivity 5.35 (2.33) 5.27 (2.03) 6.05 (2.44) 4.55 (2.78) 8.07 .007 .86 .25 1.47
SDQ Peer Problems 3.12 (2.03) 2.81 (2.25) 2.60 (2.44) 2.10 (2.47) .20 .661 .13 .45 .72
SDQ Prosocial Behavior 5.00 (2.02) 5.04 (2.62) 5.95 (2.24) 6.80 (1.96) 2.65 .111 .49 1.08 .11
SDQ Impact 3.35 (1.98) 3.85 (2.19) 3.40 (1.70) 2.00 (2.47) 8.83 .005 .90 .29 1.51
SDQ Burden .96 (.60) .65 (.63) 1.55 (.61) .55 (.83) 10.13 .003 .95 .34 1.57
CBQ 15.85 (3.27) 13.76 (4.94) 14.20 (4.49) 6.35 (4.89) 15.72 <.001 1.18 .55 1.81
PS Laxness 3.42 (.95) 3.25 (.88) 2.57 (.83) 2.01 (.76) 2.66 .110 .50 .10 1.09
PS Overreactivity 4.45 (.79) 4.04 (.073) 3.95 (1.30) 2.68 (.91) 14.23 <.001 1.15 .46 1.71
PPC Problem 7.50 (4.03) 6.67 (4.35) 7.33 (4.42) 4.07 (2.96) 4.42 .044 .73 .03 1.44
PPC Intensity 4.48 (1.59) 3.52 (1.72) 3.86 (1.03) 2.11 (1.12) 2.07 .160 .50 .19 1.20
RQI 32.56 (9.76) 36.44 (7.69) 34.87 (7.99) 35.8 (9.42) 1.34 .256 .40 .29 1.09
DASS-21 Depression 7.85 (8.63) 4.30 (5.42) 6.4 (8.07) 3.5 (6.19) .06 .814 .07 .65 .51
DASS-21 Anxiety 3.38 (5.18) 2.00 (3.10) 3.10 (3.52) 1.40 (1.60) .07 .794 .08 .50 .66
DASS-21 Stress 12.15 (7.42) 8.85 (6.40) 12.40 (7.18) 6.60 (5.73) 1.10 .300 .31 .27 .90
Note: PRE =pre-intervention assessment, POST =post-intervention assessment, SDQ =Strengths and Difficulties Questionnaire, CBQ =Conflict Behavior
Questionnaire, PS =Paren ting Scale, PPC =Parent Pr oblem C hecklis t, RQI =Relationship Quality In dex, DASS-21 =short version of the Depression Anxiety Stress
Scales; a
n
=18 for PPC Problem, PPC Intensity, RQI (18 sole parents). b
n
=15 for PPC Problem, PPC Intensity, RQI (15 sole parents, 1 missing datum and 1 parent
separating from her partner during the intervention course. She did not complete these questionnaires at post-assessment and her data was excluded when
calculating the means and standard deviations for the pre-assessment too).
44
Behaviour Change
Standard Teen Triple P
indicates that the general negative impact of the teenager’s difficulty decreased for the
families in the intervention condition and increased for the families in the waitlist
control condition. These changes were associated with large effect sizes (d>.89).
From pre- to post-assessment for the CBQ, the two-way ANOVA revealed a
significant condition by time interaction, F(1, 44) =15.72, p<.001. In the one-way
ANOVA for the CBQ there was a significant time effect for both the intervention
condition, F(1, 19) =50.63, p<.001, and the waitlist condition, F(1, 25) =4.74,
p=.039. This demonstrates an overall reduction of conflict in adolescent-parent
relationship for both conditions, but the reduction was significantly greater for the
intervention condition compared to the waitlist condition. This change was associated
with a very large effect size (d=1.18).
Parent outcomes.From pre- to post-assessment for two measures of parenting style, the
MANOVAs revealed significant condition by time interactions, F(1, 44) =6.97, p=
.002. The univariate condition by time interaction was significant at the Bonferroni-
corrected level of significance (p<.025) for the PS Overreactivity, F(1, 44) =14.23,
p<.001; but not for the PS Laxness. This indicates that the change in coercive
parenting style from pre- to post-assessment was different for the two conditions.
The one-way ANOVAs revealed significant time effects for both the intervention
condition, F(1, 19) =33.36, p<.001, and the waitlist condition, F(1, 26) =14.35,
p<.004. This indicates that parents’ use of coercive parenting practice decreased
in both conditions, but the reduction was significantly greater in the intervention
condition compared to the waitlist condition. The effect size for Overreactivity was
very large (d=1.15).
From pre- to post-assessment for the PPC Problems, the two-way ANOVA re-
vealed a significant condition by time interaction, F(1, 31) =4.24, p=.044.
In the one-way ANOVA for the PPC Problem, there was a significant time effect
for the intervention condition only, F(1, 14) =12.81, p=.003. This demonstrates
that the amount of open conflict over childrearing issues significantly decreased for
parents in the intervention condition, but did not change for parents in the waitlist
control condition. This change was associated with a medium effect size (d=.73). For
the other two-parent outcomes (RQI and the DASS subscales), the two-way ANOVA
revealed no significant condition by time interaction.
Supplementary analysis.Because gender distribution was different between the two
conditions, the data were also analysed using gender as a covariate. The results for
the two-way (condition by time) repeated measures (PRE vs. POST) ANOVA and
MANOVAs were very similar to the original two-way ANOVA and MANOVAs,
indicating that findings were not impacted by the difference in gender distribution
between the two conditions. In addition, an intention to treat analysis that included all
original 58 families regardless of whether they withdrew early from the study revealed
similar results with two exceptions. The two-way MANOVA for the SDQ subscales
and the two-way ANOVA for the PPC Problem were no longer significant. A trend
similar to the results of the main analyses was observable for these measures.
Clinical significance.The clinical significance of change was estimated for the eight
measures, with significant short-term intervention effects. For adolescent outcomes,
significant differences were observed between the distribution of positive and negative
changes in the two conditions for the SDQ Conduct Problems, χ2(1, 46) =10.73, p<
.001, the SDQ Burden, χ2(1, 46) =4.46, p=.035, and the CBQ, χ2(1, 46) =19.31,
Behaviour Change
45
Raziye Salari, Alan Ralph and Matthew R. Sanders
p<.001. In the intervention condition, 35% and 25% of families showed reliable
positive change for the SDQ Conduct Problems and the SDQ Burden, respectively. In
the waitlist control condition, no reliable change was observed for the SDQ Conduct
Problems and only 3.8% positive reliable change was observed for the SDQ Burden.
Therefore, from pre- to post-assessment, families participating in the intervention were
more likely to show reliable decreases in teen conduct problems and in the burden
of teen’s difficulties on the family. For the CBQ, 80% of families in the intervention
condition showed reliable positive changes, compared to only 15.4% of families in the
waitlist condition, indicating that families participating in the intervention were more
likely to report reliable improvements in the parent-adolescent relationship from pre-
to post-assessment. The distribution of positive and negative reliable change did not
differ between the conditions for SDQ Total, SDQ Hyperactivity or SDQ Impact.
For parent outcomes, significant differences were observed between the distribution
of positive and negative changes in the two conditions for the PS Overreactivity,
χ2(1, 46) =7.64, p=.006. In the intervention condition, 35% of parents showed
reliable positive change in this measure compared to only 3.8% in the waitlist control
condition. This indicates that parents participating in the intervention were more
likely to show reliable decreases in their use of coercive parenting practices from pre-
to post-assessment. For the PPC Problem, the distribution of positive and negative
reliable change did not differ between the conditions.
Follow-Up Effects
The one-way (time) repeated measures (PRE vs. FU) ANOVAs and MANOVAs
on adolescent and parent outcomes confirmed maintenance of all treatment gains.
Table 2 shows means and standard deviations for the adolescent and parent measures
at PRE, POST and FU for the intervention condition. It also presents Fvalues, levels
of significance and effect sizes for the univariate time effects from pre- to follow up
assessment.
Discussion
The current study evaluated the effects of STTP, a behavioural family intervention for
parents of adolescents, on several adolescent and parent outcomes. The intervention
aimed to reduce adolescent problem behaviours by reducing parents’ use of ineffec-
tive parenting strategies. As predicted, compared to parents in the waitlist control
condition, parents in the STTP group reported decreased teen disruptive problem
behaviours, reduction in the negative impacts associated with teen difficulties, and
greater improvement in the parent-child relationships. The intervention was also
associated with a greater reduction in using coercive parenting strategies, as well as
decreased disagreement over child-rearing issues in dual-parent families. No change
was observed in parent marital relationship or personal adjustment.
The results of the current study are consistent with the results of other studies
evaluating Triple P in general. These studies found Triple P to be consistently asso-
ciated with a reduction in child behavioural problems and parental use of ineffective
parenting practices, but not necessarily related to improvements in parent marital re-
lationship or parental adjustment (e.g., Bor, Sanders, & Markie-Dadds, 2002; Hoath
& Sanders, 2002; Ireland, Sanders, & Markie-Dadds, 2003; Martin & Sanders, 2003;
Matsumoto, Sofronoff, & Sanders, 2007). The results are also consistent with the out-
comes of previous studies on other variants of Teen Triple P in finding the program
46
Behaviour Change
Standard Teen Triple P
TABL E 2
Follow-Up Effects: Descriptive Statistics and Effect Sizes for the Univariate Time Effects
(Intervention Condition Only,
n
=17)a
PRE to FU time
PRE POST FU effect
Measure M SD M SD M SD F P d
SDQ Total Difficulties 16.51 6.03 10.71 7.20 9.94 5.74 31.06 >.001 .92
SDQ Emotional Symptoms 3.30 2.71 2.18 2.24 1.82 1.81 9.16 .008 .52
SDQ Conduct Problems 4.94 2.22 2.29 1.65 2.47 1.59 17.62 .001 1.28
SDQ Hyperactivity 5.76 2.44 4.18 2.81 4.12 2.55 26.46 >.001 .35
SDQ Peer Problems 2.53 2.15 2.06 2.28 1.53 1.81 6.18 .024 .41
SDQ Prosocial Behavior 5.94 2.33 7.00 1.87 6.41 2.12 .64 .436 .21
SDQ Impact 3.35 1.80 1.59 2.00 1.41 1.84 18.66 .001 1.07
SDQ Burden 1.53 .62 .53 .80 .47 .80 34.11 >.001 1.48
CBQ 13.41 4.40 5.71 3.90 6.71 4.41 63.86 >.001 1.19
PS Laxness 2.52 .84 1.92 .75 2.18 .73 3.16 .095 .43
PS Overreactivity 3.83 1.11 2.59 .85 2.82 .84 18.12 .001 1.03
PPC Problem 7.43 4.57 4.07 3.08 5.43 3.55 6.62 .023 .33
PPC Intensity 3.98 .95 2.08 1.15 2.18 1.25 14.38 .002 1.62
RQI 34.43 8.10 35.21 9.49 34.07 10.62 .03 .874 .03
DASS-21 Depression 6.35 8.43 2.00 2.83 2.59 3.86 2.65 .123 .57
DASS-21 Anxiety 3.41 3.66 1.06 1.43 1.53 2.07 5.36 .034 .63
DASS-21 Stress 12.59 7.48 5.65 4.49 8.24 6.63 3.72 .072 .62
Note: Effect sizes were provided for PRE versus FOLLOW-UP. PRE =pre-intervention assessment, POST
=post-intervention assessment, FOLLOW-UP =3-month follow-up assessment, SDQ =Strengths and
Difficulties Questionnaire, CBQ =Conflict Behavior Questionnaire, PS =Parenting Scal e, PPC =Par ent
Problem Checklist, RQI =Relationship Quality I ndex, DASS-2 1 =short version of the Depression
Anxiety Stress Scales. a
n
=14 for PPC Problem, PPC Intensity, RQI (2 sole parents, 1 missing datum).
to be effective in reducing teen problems, parent-child conflict and dysfunctional
parenting (Ralph & Sanders, 2003; Stallman & Ralph, 2007).
Improvements in parenting practices are in line with other studies on parenting
programs for parents of teenagers, which show these programs are effective in increas-
ing parents’ use of positive strategies (e.g., Hawkins et al., 1991). However, previous
studies have mostly focused on changes in parental monitoring (Dishion, Nelson, &
Kavanagh, 2003). This study is one of the first attempts to measure the effects of
parenting programs on more general parenting practices. Positive changes in adoles-
cent behaviour and parent-adolescent relationships have also been observed in other
studies. Parenting programs have been shown to be effective in improving parent-
adolescent relationships and reducing the risk of substance abuse and delinquent
behaviour in teenagers (Barkley et al., 2001; Dishion & Andrews, 1995; Kosterman,
Hawkins, Spoth, Haggerty, & Zhu, 1997). In addition, the current study shows that
parenting programs not only improve parenting skills and adolescent behaviour, but
also increase parents’ agreement over child-rearing issues.
Behaviour Change
47
Raziye Salari, Alan Ralph and Matthew R. Sanders
In this study, the overall rate of attrition in the intervention condition was 34.4%
(including families who failed to start the intervention, families who attended at
least one session but did not complete the program, and the family who completed
the intervention but did not return the post-assessment questionnaires). These rates
are similar to attrition rates cited in other parent training and child and adolescent
treatment studies (Boggs et al., 2004; Cottrell et al., 1988; Gross & Grady, 2002;
Hoare, Norton, Chisholm, & Parry-Jones, 1996). In a meta-analysis, the average rate
of terminating the treatment prematurely was estimated to be between 40 to 60% for
studies on child psychotherapy (Wierzbicki & Pekarik, 1993).
Comparisons of families who completed the program and those who failed to start
or who dropped out early revealed that dropout mothers were less educated and younger
compared to completer mothers. These are among the most common differences found
between child treatment dropouts and completers (Kazdin, 1990; Kazdin, Mazurick,
&Bass,1993;Wierzbicki&Pekarik,1993).Youngermothersaremorelikelyto
experience higher levels of stress, which can interfere with their attendance in child
treatment (Kazdin et al., 1993). Similarly, lower educational attainment is related to
lower socioeconomic status and higher levels of life stress and may hinder parents’
ability to cope with treatment demands (Kazdin, 1990).
Limitations
This study has several limitations that warrant comment. To begin with, intervention
outcomes were assessed through self-report measures only. This presents a potential
limitation because parents participating in the intervention are more likely to be
aware of socially desirable responses that may specifically affect their ratings of their
own parenting behaviours despite no change in the real behaviour (Spoth, Redmond,
Haggerty, & Ward, 1995). Observational measures of parent adolescent interaction
would have been useful, but were not carried out due to financial and time constraints.
Second, the small sample size did not allow examination of moderators and medi-
ators of intervention effects. Factors contributing to the intervention outcomes, such
as characteristics of families who respond well and did not respond so well, could
not be examined due to the small sample size. In addition, improvements in other
measures such as permissive parenting may have reached significance if the sample
size had been larger. Nevertheless, the study yielded significant results in several ado-
lescent and parent outcome measures, implying the robustness of the intervention
in reducing family risk factors for adolescent problem behaviours. This was achieved
even in spite of the conservative approach adopted in choosing which parents’ data
would be included in the analysis in cases where more than one parent per family had
completed the questionnaires.
Another limitation was the lack of a control group at the follow-up assessment. Al-
though families in the intervention condition showed significant improvement over
families in the waitlist control condition and had maintained most of the treatment
gains at follow-up, the positive changes from baseline to follow-up cannot confidently
be attributed to the intervention in the absence of a long-term control group. Factors
unrelated to the intervention, such as maturation, regression to the mean, or contem-
poraneous events may have accounted for changes observed from pre- to follow-up
assessment. For ethical reasons, research participants who were experiencing high
levels of difficulties at baseline (as was the case in this study), could not be deprived
from receiving intervention for a long period. The alternative approach would have
48
Behaviour Change
Standard Teen Triple P
been to compare the intervention with treatment as usual, which allows for long-term
follow-ups. However, treatment as usual could not be used as a comparison condition
in the current study, because the study was carried out in a university clinic where
Triple P was the predominant treatment of choice.
It is also worth mentioning that recruitment of families into this study was dif-
ficult. The recruitment rate could not be estimated, because the number of eligible
families reached through program advertisement was unknown. Nevertheless, the re-
sponse rate to the recruitment was slower than expected and thus some families were
assigned to the intervention or waitlist control condition based on the availability
of practitioners (see method section for more details). Even though families in the
intervention condition did not differ from families in the waitlist control condition in
most socioeconomic variables and child and family functioning measures, caution is
warranted in generalisation of the findings. There is some evidence that suggests preva-
lence of emotional and behavioural problems in children and adolescents (Carskadon
&Acebo,1993;Sourander,Koskelainen,&Helenius,1999)aswellaspatternsof
parent-child involvement (Crouter & McHale, 1993) might vary according to the
time of year. Therefore, families who responded to the advertisement between April
and August might be different from families who initiated contact later during the
year.
Implications for Research, Policy, and Practice
Despite the limitations, this research demonstrated that STTP is an effective inter-
vention in reducing parents’ use of coercive and punitive parenting practices and
adolescent disruptive behaviours, as well as improving the parent-adolescent relation-
ships and parents’ communication about parenting issues. The intervention is directed
at parents and includes minimal therapeutic contact with adolescents. Adolescents
are encouraged to participate, but their participation is not necessary. This allows all
parents of teenagers to receive the program, even those whose teenager is not willing
to attend the sessions.
Nevertheless, the program should be compared to treatment as usual in an effec-
tiveness trial. This design allows for examination of the long-term intervention effects.
Families in the intervention condition can be compared to families in the treatment-
as-usual condition for up to several years, without compromising the ethical issue of
depriving families of receiving appropriate intervention. Moreover, a program that is
demonstrated to be more effective than the services currently available justifies the
efforts and costs associated with incorporating a new program into the existing system.
In conclusion, STTP is a promising parenting intervention for tackling adolescent
externalising problems. Future trials will benefit from the inclusion of observational
measures of change, a larger sample size and establishing the long-term efficacy of the
intervention.
Author Note
Raziye Salari now works at the Department of Women’s and Children’s Health,
Uppsala University, Samariterhemmets Hospital, Box 609, 751 25 Uppsala, Sweden.
Acknowledgments
The first author would like to thank Alina Morawska for thoughtful discussions and
Cassandra Tellegen for her helpful comments on an earlier draft of the manuscript.
Behaviour Change
49
Raziye Salari, Alan Ralph and Matthew R. Sanders
This paper is drawn from a doctoral dissertation by the first author which was supervised
by the second and third authors.
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Behaviour Change
... The program's main concern is to help improving parents' positive skills in parenting their children (Ralph & Sanders, 2004). Parents' self-regulation framework in each session was analyzed for parents to be able to alter their behaviors and become active and independent problem solvers (Salari, Ralph, & Sanders., 2014;Sanders, 2008). Learning process applied in the program was observational learning which encompasses four stages: attention process, retention process, motor production, and motivational process (Bandura, 1989). ...
... "Effective Communication" session facilitated mothers to understand and exercise effective coomunication to aid teenagers in expressing thoughts and feelings, stimulating mind, and transferring parents' values and objectives. Positive Parenting Program could improve harmony in family interaction (Leung & Lee, 2012;Salari et al., 2014). When parents act warm and responsive, adolescents will feel accepted and comfortable to disclose information (Brooks, 2011). ...
... The program had a tagline "Loving with Art, Educating Wholeheartedly, Becoming True Parents". Authors developed the program by supplementing contents adjusted to parents's needs in parenting teenagers (Ralph & Sanders, 2004;Salari et al., 2014), adding activity procedures and delivery methods (Ralph & Sanders, 2004;Salari et al., 2014), extending the duration to total of ±13 hours, referring to minimum of 8 hours for the entire sessions (Ralph & Sanders, 2004;Salari et al., 2014), and including understanding adolescent characteristics and relaxation sessions. All sessions had undergone module validity testing. ...
Article
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Parenting efficacy is essential in parenting quality. This study aimed to devise and determine the Positive Parenting Program effect in improving the parenting efficacy of mothers with teenage children. The study tested two hypotheses. First, the Positive Parenting Program had good content validity. Secondly, the Positive Parenting Program could improve the parenting efficacy of mothers. The study involved 27 mothers subjects (13 subjects of the experimental group and 14 subjects of the control group). The experiment was carried out using the method of ‘Untreated control group design with dependent pretest and posttest samples’ involving three measurements at pretest, posttest, and follow-up. The results proved that the Positive Parenting Program Module had good content validity. The module has a high content validity with Aiken's V coefficients in each session ranging from 0.89 to 0.95 with an average of 0.92. The second hypothesis test was performed by Mann Whitney U Test analysis. The results of the study also showed that the Positive Parenting Program significantly improved the parenting efficacy of mothers (Zposttest-pretest= -4,321, p = 0.001 (p <0.05), Zfollow-pretest= -4,423, p = 0.001 (p <0,05)).
... Massive researches have been done about the effect of group Triple-P on relationships of mother-child in different age and groups. Salari et al. (2014) investigated the effectiveness of group Triple P in reducing adolescent problem behaviors by reducing parents' use of ineffective parenting strategies. Parents in the group Triple-P reported lower teen disruptive problem behaviors, reduction in the negative impacts associated with teen difficulties, and greater improvement in parent-child relationships. ...
... Findings showed that the group Triple-P had a positive effect on the promotion of closeness, dependency, and relationships of mother-child and decreased conflicts of mother-child with ID. The findings are in agreement with many studies (Salari et al., 2014;Abedi-Shapourabadi, 2012;Fujiwara et al., 2011;Graaf, 2008a;Graaf, 2008b;Roushanbin et al., 2007;Ercan et al., 2005;Hajebi et al., 2005;Gorji, 2004;Dore & Lee, 1999;Barkley, 1994;Pisterman et al., 1992). Several studies showed that there was a positive and significant relationship between group Triple-P and relationships of mother-child (Glazemakers & Deboutte, 2012;Abarashi, 2009). ...
Article
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Objec􀆟ve Intellectual disability affects all aspects of individual’s life, while use of paren􀆟ng educa􀆟onal programs has been associated with strong outcomes. The aim of the present research was to determine the effec􀆟veness of posi􀆟ve paren􀆟ng program (Triple-P) training on interac􀆟on of mother-child with intellectual disability. Materials & Methods The present research was a quasi-experimental study by pre-test, post-test design and control group. The study popula􀆟on included 40 mothers of children with intellectual disability in Varamin and Pakdasht provinces who were selected by random clustering method from excep􀆟onal schools. Par􀆟cipants were divided into two groups (experimental and control group), each of which was consisted of 20 individuals. Experimental group received Triple-P in 10 sessions while control group did not. The instrument of present research was parent child rela􀆟onship scale (PCRS) of Piyanta (1994). The obtained data were sta􀆟s􀆟cally analyzed by MANCOVA using SPSS (version 16). Results Findings showed that experimental and control groups had significant difference at least in one of subscales of the PCRS (P<0.001). The final results of MANCOVA revealed that Triple-P had significant and posi􀆟ve effect on the conflict, closeness, dependency, and posi􀆟ve rela􀆟onship (P<0.001). Conclusion The results indicated that Triple-P training has led to the improvement of interac􀆟on of mother- child with intellectual disability. It is suggested that specialists promote interac􀆟on of mother-child with intellectual disability with implementa􀆟on of Triple-P training.
... This transition can be challenging for adolescents and their parents. 3 Usually, the child's adolescence coincides with the parents' middle age. 4 The world has seen rapidly growing middle-aged population over the past decade. 5 In Iran, this age transition, which is accompanied by an increase in the middle-aged population, is taking place as well. ...
Article
Background: Most parents consider adolescence to be the most difficult stage of parenting. Parental practice is a determining factor in adolescents' outcomes. Mothers play the main role of parenting in Iran. Coinciding the transition of adolescence with the transition of middle-aged mothers can affect the mothers' parenting practice. The present study aimed at explaining the Iranian mothers' practice in parenting an adolescent child. Methods: This qualitative conventional content analysis was conducted from July 2018 to November 2019 in Kashan. 21 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. The data were analyzed through conventional content analysis. Data collection and analysis were performed simultaneously using MAXQDAv10 software. Results: Regarding the study objectives, two themes and six main categories were identified. The theme of 'laying the groundwork for upbringing' was detected by two main categories: 'meeting the needs and 'effective interaction with the adolescent'; also, the theme of 'individual-social capacity building' was explained by four main categories: 'helping to gain independence', 'modeling individual-social behavior', 'socializing the adolescent', and 'preparing to accept future roles'. Conclusion: Mothers' practice was mainly focused on adolescents' independence, college education, career prospects, and marriage preparation and respect for older adults. Consistent with this transition to modernity, and contrary to the collectivist values of Iranian society, mothers' practice was in line with developing adolescents' independence and building their self-confidence, which is close to the authoritative parenting style.
... This issue concerns not only children and adolescents but also older people. As a rule, the parenting styles of previous generations do not take into account modern realities since the types of situations faced by modern parents have changed significantly [1][2][3][4][5][6]. To make the necessary life decisions, people need to know how they feel about certain things, which requires public images of such sensations [7]. ...
Article
Full-text available
While observing the difficulties that parents experience in communicating with their adolescent children (for example, ignoring, misunderstanding, or underestimating the problems faced by teenagers, inability to build trust-based relationships, difficulties in discussing complex topics of interpersonal relationships, life choices, school problems, self-determination, etc.), the authors emphasized the need to search for methodological tools that can help overcome these problems of intergenerational communication through developing the culture of experience among parents. A film club for parents was chosen as a method. 30 parents of children (4–20 years old) watched a German TV series DRUCK (based on a Norwegian TV series SKAM) in Moscow from January to December 2020 offline and online. The functioning of this club was built over the methods of polylogue, non-judgmental interview, and amplification of sense. Observations, questionnaires, and interviews of the club members at the end of meetings allowed the authors to conclude the effectiveness of such a format for developing the culture of experience among parents and improving intergenerational relations. It was also proved that teen series have a great potential for developing the culture of experience among parents since they address topics relevant for teens and help observe the emotions and behavior of teens in a psychologically safe environment. Based on the study results, the authors developed methodological recommendations for organizing such film clubs and holding meetings for parents.
... Program variants have been tested with parents of children with disabilities (e.g., autism spectrum disorder, intellectual impairment, physical disabilities, traumatic brain injuries, fetal alcohol spectrum disorder); chronic health conditions (e.g., diabetes, asthma, eczema, obesity, recurrent pain syndromes); feeding disorders; anxiety disorders; and peer relationship difficulties and with parents of gifted and talented children. There are studies evaluating applications of Triple P with infants (e.g., Ferrari, Whittingham, Boyd, Sanders, & Colditz, 2011); toddlers (e.g., Tully & Hunt, 2015, 2017; preschoolers (e.g., Franke, Keown, & Sanders, 2016); school-aged children (e.g., McTaggart & Sanders, 2003); and adolescents (e.g., Salari, Ralph, & Sanders, 2014). As the program has become more widely disseminated, researchers and agencies have implemented Triple P with an increasingly heterogeneous sample of parents. ...
Chapter
Innovation has characterized the whole field of behavioral family intervention since its inception. This chapter reflects on the innovative developments that have occurred over the past four decades as the field of evidence-based parenting support has evolved in response to cumulating evidence relating to effectiveness. Despite these advances, it is argued that new approaches are needed to improve outcomes in many areas of unmet need and to address contemporary issues for new generations of parents. The challenge is to deliver evidence-based parenting support on a global scale and thereby substantially enhance the well-being of all children, families, and communities. The organizational contexts and research environments that are likely to nurture a thriving culture of program innovation while training the next generation of parenting researchers and program developers are discussed.
... The empirical support for Teen Triple is less substantial than that cited above for Triple P but is steadily being amassed with positive outcomes being reported for the seminar program (Chand, Farruggia, Dittman, & Sanders, 2013), the group program (Chu, Bullen, Farruggia, Dittman, & Sanders, 2014;Kliem, Aurin & Kroger, 2014;Ralph & Sanders, 2003, the self-directed program (Doherty, Calam, & Sanders, 2013;Stallman & Ralph, 2007), and the more intensive standard program (Salari, Ralph, & Sanders, 2014). The main outcomes reported include significant improvements in parenting behavior and confidence, reductions in adolescent conduct problems, reduced conflict between parents and adolescents, and improved family relations and parents' psychological adjustment A literature review of the parenting programs currently used in Turkey indicated that most had not been tested with randomized controlled trials. ...
Article
Full-text available
Aim To evaluate the effectiveness of Group Teen Triple P with parents who have behaviorally disturbed adolescents. Methods The research was conducted in an experimental manner. The sample was 76 parents who were grouped as 38 cases and 38 controls with a block randomization method. Data were collected using the Family Background Questionnaire, General Health Questionnaire (GHQ‐12), Strengths and Difficulties Questionnaire (SDQ), Conflict Behavior Questionnaire (CBQ), and Parent Satisfaction Questionnaire. Group Teen Triple P Program was implemented with the case group for 8 weeks. Data were collected immediately after the program and again after 3 months. Data were evaluated using variance analysis, t test, χ ² test, multivariate analysis of covariance, and analysis of covariance test. Results It was found that participation in Group Teen Triple P resulted in the improvement of parental mental health, decreased problematic behavior of the adolescents, and fewer problems between adolescents and their parents. Conclusion Group Teen Triple P should be made available to more parents of adolescents in Turkey.
... A small number of parenting programs specifically target the adolescent period, including the Teen Triple P-positive parenting program (Teen Triple P; Ralph and Sanders 2003), strengthening families program (Molgaard and Spoth 2001), nonviolent resistance training (Omer and Lebowitz 2016) and the ABCD parenting young adolescents program (Burke et al. 2012), as well as the multi-level, school-based family intervention, the family check-up (Stormshak and Dishion 2009). These programs have been shown to achieve positive outcomes for families and adolescents, including reductions in parent-adolescent conflict (Chu et al. 2015;Kumpfer et al. 2010;Salari et al. 2014) and reductions in adolescent behavior problems (Burke et al. 2012;Chu et al. 2015;Kumpfer et al. 2010;Omer and Lebowitz 2016;Stormshak and Dishion 2009). ...
Article
Full-text available
Background There is a need for research to evaluate the feasibility and efficacy of alternative delivery methods to make evidence-based parenting programs more accessible to parents of teenagers.Objective This study aimed to test the efficacy of a 2-h parenting discussion group for parents of adolescents experiencing family conflict. It was hypothesised that parents attending the discussion group would report reductions in family conflict and adolescent behavior problems and improvements in the parent–adolescent relationship and parenting in comparison to control parents.Method This study was a randomized controlled trial. Ninety parents of teenagers (11–16 years; M = 13.23 years) were randomly allocated to intervention (n = 43) or waitlist conditions (n = 47) and completed questionnaires of parent–adolescent and family conflict, adolescent behavior, the parent–adolescent relationship and parenting at pre- and post-intervention and 6-month follow up.ResultsAt post-intervention, intervention parents reported greater declines in adolescent oppositional behavior problems in comparison to controls. No intervention effects were found for parent–adolescent or family conflict, or for the parent–adolescent relationship and parenting practices.Conclusions Brief parenting interventions may offer an alternative strategy for supporting parents to deal with challenging adolescent behavior, but further research is required to determine if this type of brief and targeted intervention is effective for family conflict. Such research is important given the need for effective and easily deployable prevention and intervention approaches that address a problem that has significant impact on adolescent wellbeing and family functioning.
... In this study, the rate of terminating the treatment in Triple P group was 96.7% which is more than the average rate of termination (about 40-60%) in child psychotherapy studies. The rates of attrition in different studies on parental management training and child treatment are consistent with the results of this study (Boggs et al., 2005;Salari, Ralph, & Sanders, 2014). ...
Article
This study considered the effect of Triple P as a behavioural family intervention on mothers of children with separation anxiety disorder. Three hundred families with separation anxious children participated in this research which divided into intervention and control groups. The measuring tools were Parenting Scale, Depression Anxiety Stress Scale-42, Parental Bonding Instrument, Child Behavior Checklist and Client Satisfaction Questionnaire. The results showed that mothers in the intervention condition reported more improvements in parenting style and mother–child relationship than those in the control condition. Women were trained in the Triple P group also reported significantly lower rates of maternal depression, anxiety, stress and child misbehaviours than those in the control group. Iranian mothers reported high satisfaction with this intervention. In conclusion, positive parenting programme is an effective intervention in several aspects for mothers of children with separation anxiety disorder and their children.
... Examples of such programmes are The Incredible Years (The IY;young children;Webster-Stratton 2006), Parent Management Training Oregon Model (PMTO;Askeland, Apeland, and Solholm 2014;Forgatch and DeGarmo 1999;Forgatch, Patterson, and DeGarmo 2005), Triple P-Positive Parenting Programme (Sanders 1999), and Multisystemic Therapy (MST, for youth; Henggeler et al. 1998). Generally, such programmes have been found to be effective in reducing child behaviour problems ( Jones et al. 2008;Ogden and Hagen 2008;Salari, Ralph, and Sanders 2014;Stattin et al. 2015). ...
Article
In this pilot study, we examined whether a 2-day Emotion-Focused Family Therapy workshop strengthened parental self-efficacy, satisfaction and beliefs regarding their ability to help their children regulate emotions and reduce the children’s symptoms of behavioural- or psychological difficulties. Twenty-three caretakers with 17 children (9 boys) aged 6 to 12 years old completed the workshop. Pre, post and 3-month follow-up data on the Parents` Beliefs About Children`s Emotions – Guidance scale and Parenting Sense of Competence scale, as well as pre and 3-month follow-up data on the Child Behaviour Checklist parent form, were used to assess the effects of the intervention. Parental self-efficacy significantly increased, the caretakers` satisfaction in the parenting role significantly increased but faded after 3 months and the caretakers` beliefs that children can guide their emotions on their own were significantly reduced. Finally, oppositional defiant problems in the children significantly declined.
Article
Triple P is a parenting programme used in the youth healthcare practice of many Dutch municipalities to support parents in raising their children. According to international research, this Australian intervention is effective for parents with children up to the age of 12. It shows positive effects on parenting skills and on the reduction of both parents' child-rearing stress and their children's behavioural and emotional problems. Our study examined the effectiveness of Teen Triple P level 4: a training programme for parents of teenagers aged 10–16. The programme included five group sessions of 1.5–2 h each, as well as three individual (phone) consultations. Through a matching procedure, 103 parents who participated in Teen Triple P were compared in a quasi-experimental study with 397 parents in a control group. Compared with the control group, parents who received the Teen Triple P training reported a significant improvement in their parental practice. Now, they are more involved with their child, more responsive to the needs of the children, and they report fewer parent–child conflicts. Some positive differences in behavioural problems among adolescents, as reported by their parents, could be found among the experimental group. These findings remained the same at the follow-up.
Article
Full-text available
Three studies examine beliefs that parents and teachers have about adolescents. A distinction is made between category-based beliefs (concerning adolescents as a group) and target-based beliefs (concerning individual adoles cents). In Study 1, 90 late elementary and junior high school teachers indicated degree of agreement with a set of category-based statements about adolescents. Parents of early adolescents in Study 2 (N=1272) responded to category- and target-based statements. Study 3 compares the responses of teachers in Study 1 and parents in Study 2. Both teachers and parents endorsed beliefs that adolescence is difficult, and that adults can have an impact. Compared to fathers, mothers believed more in difficulty and in the negative effects of biological change on behavior. Parents of daughters believed adolescence is more difficult than parents of sons. Among teachers, amount of experience with adolescents was positively associated with the belief that adolescence is a difficult period of life. For parents, the effect of amount of experience was mixed. Experience had a greater impact on the category-based beliefs of teachers than parents. Possible influences on the origins and modification of beliefs are discussed.
Article
Parenting practices and parent-child relationships affect adolescent adjustment. This study examined the efficacy of a self-directed parenting intervention for 51 parents of early adolescents (aged 12-14 years), who reported experiencing difficulties with their adolescent's behaviour. Two levels of intensity of a self-directed intervention (self-directed alone and self-directed plus brief therapist telephone consultations) were compared with a waitlist control group. At post-intervention, parents in the enhanced condition reported significantly fewer adolescent behavioural problems and less use of over-reactive parenting strategies than parents in either the standard or waitlist conditions. Improvements were maintained at 3-month follow-up. This research suggests that a self-directed behavioural family intervention with minimal therapist contact may be an effective early intervention for adolescent problems. It has implications for providing minimally sufficient interventions for parents using a multilevel approach to intervention as well as for making interventions more accessible for families.
Article
Two measures of marital satisfaction, the Quality of Marriage Index (R. Norton, 1983) and the Relationship Satisfaction Questionnaire (D. D. Burns & S. L. Sayers, 1992) were compared to a measure of marital adjustment, the Dyadic Adjustment Scale (G. B. Spanier, 1976). The measures showed excellent convergent validity (high correlations among each other and with other measures of marital functioning) and discriminant validity (low or nonsignificant correlations with psychopathology subscales). However, spouses' ratings of frequency of disagreements differed significantly from their ratings of satisfaction in the same areas. Formulas for converting scores among the measures are given, and the measures were found to have modest classification powers. The relative advantages and disadvantages of adjustment and satisfaction measures are discussed, and recommendations are made for when to use each type of measure.
Article
This controlled study incorporates multimethod measurement procedures and addresses several deficiencies noted in prevention-focused parent skills training outcome literature. Conventional ANCOVA analyses of intervention group versus control group differences on (a) protective parenting behaviors directly targeted by the intervention and (b) general child management skills, in a sample of families residing in an economically stressed rural area (n = 209), showed significant intervention effects on both measures for both mothers and fathers. Results also indicated that both mothers' and fathers' level of intervention attendance and expressed readiness for parenting change were significant predictors of the targeted parenting outcome, as was parent self-efficacy among mothers. The targeted parenting outcome, in turn, significantly affected the general child management outcome for both mothers and fathers. Finally, findings showed a significant interaction of intervention attendance and intervention-targeted parenting behaviors at pretest for fathers.
Article
This paper critically examines the operationalization of marital quality indices used as dependent variables. First, it looks at the functioning and construction of marital quality variables. In particular, Spanier's Dyadic Adjustment Scale is used to illustrate the arguments. Second, it presents both semantic and empirical criteria to judge the development of a marital quality index. Finally, it presents a Quality Marriage Index (QMI) based on the introduced criteria. This index was constructed using data from 430 people across four states. Several advantages of the QMI over more traditional measures are shown in terms of how covariates relate to the index.
Article
Background: Despite a wealth of evidence showing that behavioural family intervention is an effective intervention for parents of children with behavioural and emotional problems, little attention has been given to the relationship between parents functioning at work and their capacity to manage parenting and other home responsibilities. This study evaluated the effects of a group version of the Triple-P Positive Parenting Program (WPTP) designed specifically for delivery in the workplace. Method: Participants were 42 general and academic staff from a major metropolitan university who were reporting difficulties managing home and work responsibilities and behavioural difficulties with their children. Participants were randomly assigned to WPTP, or to a waitlist control (WL) condition. Results: Following intervention, parents in WPTP reported significantly lower levels of disruptive child behaviour, dysfunctional parenting practices, and higher levels of parental self-efficacy in managing both home and work responsibilities, than parents in the WL condition. These short-term improvements were maintained at 4-months follow-up. There were also additional improvements in reported levels of work stress and parental distress at follow-up in the WPTP group compared to post-intervention. Conclusions: Implications for the development of 'family-friendly' work environments and the prevention of child behaviour problems are discussed.