An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong

The present study evaluated the effectiveness of the Positive Parenting Program (Triple P) with a sample of Chinese parents of children with early onset conduct-related problems in Hong Kong. The participants consisted of 91 parents whose children attended maternal and child health centers and child assessment centers for service, and were between three to seven years old. Participants were randomly assigned to the intervention (TP) and a waitlist control group (WL). There was no significant difference in pre-intervention measures between the two groups. However, at post intervention, participants in the TP group reported significantly lower levels of child behavior problems, lower dysfunctional parenting styles, and higher parent sense of competence, compared to the WL group. Implications of these findings for the use of Triple P with families of Chinese descent are discussed.     

Behavioral Outcomes of Parent-Child Interaction Therapy and Triple P—Positive Parenting Program: A Review and Meta-Analysis

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.

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.     

Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

Parent-centred interventions for childhood obesity aim to improve parents' skills and confidence in managing children's dietary and activity patterns, and in promoting a healthy lifestyle in their family. However, few studies assess changes in parenting over the course of treatment. This study describes the evaluation of a lifestyle-specific parenting program (Group Lifestyle Triple P) on multiple child and parent outcomes. One-hundred-and-one families with overweight and obese 4- to 11-year-old children participated in an intervention or waitlist control condition. The 12-week intervention was associated with significant reductions in child BMI z score and weight-related problem behaviour. At the end of the intervention, parents reported increased confidence in managing children's weight-related behaviour, and less frequent use of inconsistent or coercive parenting practices. All short-term intervention effects were maintained at one-year follow-up assessment, with additional improvements in child body size. The results support the efficacy of Group Lifestyle Triple P and suggest that parenting influences treatment outcomes. Further research is needed to evaluate the long-term effectiveness of the intervention and to elucidate the mechanisms of change.     

Triple P-Positive Parenting Program as a public health approach to strengthening parenting

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed.     

A Randomized Controlled Trial of Group Stepping Stones Triple P: A Mixed‐Disability Trial

Stepping Stones Triple P (SSTP) is a parenting program designed for families of a child with a disability. The current study involved a randomized controlled trial of Group Stepping Stones Triple P (GSSTP) for a mixed‐disability group. Participants were 52 families of children diagnosed with an Autism Spectrum Disorder, Down syndrome, Cerebral Palsy, or an intellectual disability. The results demonstrated significant improvements in parent‐reported child behavior, parenting styles, parental satisfaction, and conflict about parenting. Results among participants were similar despite children's differing impairments. The intervention effect was maintained at 6‐month follow‐up. The results indicate that GSSTP is a promising intervention for a mixed‐disability group. Limitations of the study, along with areas for future research, are also discussed.     

Effects of a Brief Parenting Intervention In Shelters For Mothers And Their Children Experiencing Homelessness

This study was designed to examine the effectiveness of an evidence-based parenting program—Triple P Positive Parenting Program—in shelter settings for families experiencing homelessness. The intervention has not previously been evaluated in a shelter setting, where there is a critical need for evidence-based parenting programs. Using a within-group pre- and post-intervention with 3-month follow-up design, 39 mothers residing in a shelter with a child ages 2–6 years participated. Results of this preliminary study showed positive effects of Triple P Discussion Groups. There were significant improvements in mother-reported parenting practices and child behavior across time, but no change in child maltreatment risk as measured by the Brief Child Abuse Potential Inventory. Mothers rated satisfaction with the program high immediately after the group and again three weeks later. Results showed Triple P Discussion Groups are acceptable and have some positive effects for this vulnerable population in need of parenting support. We discuss implications of findings, limitations of the study (including a 33% attrition rate), and recommendations for further study.

     

Risk factors for child physical abuse

We review the risk and protective factors for child physical abuse (CPA). An etiological model based on moderate to strongly supported risk factors would begin with distal perpetrator variables of being abused as a child/teen and receiving less family social support as a child. Next might come current family variables such as parents' youth, father's drinking, and family's living in a community that is impoverished and/or has a lower percentage of two parent families. More proximal variables that increase the probability of parents, especially mothers, employing severe or abusive physical tactics could include mothers' dysphoria (e.g., unhappiness, emotional distress, anxiety, loneliness and isolation, depression, somatic complaints, interpersonal problems, feelings of incompetence as a parent, a tendency toward becoming upset and angry), and stress (more stressful life events, including parenting and other family stresses) and coping (most likely a protective factor, including problem solving and social support). Finally, risk factors that are proximal to abuse could include mothers' high reactivity (impulsivity, high negative affect and autonomic nervous system arousal), high-risk parenting (harsh discipline strategies, verbal aggression, yelling), and negative attributions, and children's behavior problems (e.g., socialized aggression, attention deficits, and internalizing and externalizing problems).     

Evaluating Triple P Online: A Digital Parent Training Program for Child Behavior Problems

Triple P Online (i.e., TPOL; www2.tripleponline.net) is an online self-help parent training program aimed at reducing child behavior problems through “positive parenting practices”—available at time of review for $79.95. TPOL is comprised of 8 video-based modules that also incorporate in-session activities and homework. Randomized control trials have shown that TPOL effectively reduces child behavior problems. The program’s main strengths include very high-quality content with an abundance of relevant and easily locatable resources, an easy-to-use interface, and a professional look and feel. The program’s main weakness lies in its lack of monitoring and adaptation to the user’s state (e.g., child’s and parent’s behaviors), and real-time reminders for desired actions. Altogether, TPOL is an extremely valuable and important resource for families seeking evidence-based treatment for child behavior problems.     

父母积极教养课程及其在中国的社会和文化适应

基于社会学习理论的父母教养课程被普遍视为预防儿童青少年行为问题以及促进儿童身心健康的“黄金标准”。父母积极教养课程（Triple P – Positive Parenting Program）是其中的主要代表。本文详尽介绍了Triple P的理论基础、干预体系、课程内容以及实证研究结果,分析了该课程存在的优势以及缺陷。此外,本文结合中国家庭的特点和需求,探讨了该课程运用于中国家庭时可能会遇到的挑战,同时提出了改良的方向,为家庭干预实践工作者和研究人员提供了新的视角。     

Parenting anxiety and stress: does gender play a part at 3 months of age?

In this study, the authors compared 90 pairs of mothers and fathers with respect to aspects of negative emotionality experienced in the early parenting role. Mothers and fathers of 90 healthy 3-month-old infants completed questionnaires pertaining to parenting stress and separation anxiety. Mothers reported significantly higher levels of negative emotionality than did fathers. An interaction effect of parent with child gender on the level of parenting stress was indicated. Mothers of sons reported more stress than did mothers of daughters. The child's gender was not related to the level of separation anxiety expressed by mothers and fathers. The findings suggested that, at 3 months of age, the child's gender plays a role in the parenting experience, but the impact is (a) moderated by the parent's gender and (b) construct-specific (e.g., stress). These findings are in line with a multidetermined model of parenting.     

The Efficacy of a Group Triple P (Positive Parenting Program) for Chinese Parents with a Child Diagnosed with ADHD in Hong Kong: A Pilot Randomised Controlled Study

The present pilot study evaluated the efficacy of the Level 4 Group Positive Parenting Program (Triple P) with Hong Kong Chinese parents who had a child with attention deficit/hyperactivity disorder (ADHD), using a randomised controlled trial design. It was a mixed research method involving quantitative measurement and semi‐structured focus group. Participants were randomly assigned to Triple P (n = 8) or control group (n = 9) and completed measures on child disruptive behaviours, sense of parenting efficacy and satisfaction, family stress and service needs. Outcomes were assessed at pre‐, post‐, and 3‐month follow‐up. A focus group was also conducted with the participants in the intervention group upon the programme completion. Compared with the control group, the intervention group reported a significant reduction in intensity of child behaviour problems and a significant increase in parenting efficacy at post‐intervention. The gain in reducing intensity of child disruptive behaviours maintained to 3 months after the completion of programme. Qualitative data suggested the three key elements to help both parents and children get positive changes: understanding and empathy, emotional control, and persistence in applying positive parenting strategies. The results partially provided preliminary evidence supporting the efficacy of Triple P in reducing child behaviour problems for ADHD in Chinese society.     

Helping families improve: an evaluation of two primary care approaches to parenting support in the Netherlands

The present study evaluated two primary care parenting interventions. First, we evaluated the most widely used Dutch practices for primary care parenting support. Second, we assessed the applicability of the Primary Care Triple P approach, which is now being utilized in a wide variety of primary care settings. Both interventions target parents of children with mild to moderate behavioural and/or emotional problems, with the aim of improving parenting skills and thereby decreasing child problems. We examined the interventions in pre‐, post‐ and follow‐up assessment, and compared the results. Both interventions produced significant reductions in reported child emotional and behaviour problems, that also remained after 3 months. For both groups, parenting styles were also found to have improved at both post‐test and follow‐up measurement. When compared with the regular Dutch parenting consultation practices, however, the Primary Care Triple P approach produced greater reductions in parental laxness and total parenting dysfunction, and greater improvement in total parenting competence at both post‐test and follow‐up. Primary Care Triple P may even—in light of the greater improvements in parenting skills and total parental competences in the Triple P group than in the regular Dutch parenting consultation group—produce better results in the long run concerning child behaviour and emotional problems. Copyright © 2009 John Wiley & Sons, Ltd.     

Promoting Positive Relationship Between Parents and Grandparents: A Randomized Controlled Trial of Group Triple P Plus Compassion in Vietnam

In Vietnamese culture, grandparents are significantly involved in the upbringing of grandchildren. This involvement of grandparents entails lots of ambiguities and challenges. Boundaries between parents and grandparents are often unclear, and communication can be restricted due to power differentials, leading to inconsistent discipline. This study seeks to evaluate the efficacy of the Group Triple P–Positive Parenting Program plus Building Coparenting Alliance—a compassion-focused module to promote the parent-grandparents relationship. One hundred Vietnamese parents whose parents or parent in-laws provided care for their children were randomly assigned to either an intervention condition (n = 50) or a waitlist control condition (n = 50). Both groups were assessed at three time-points (pre-intervention, post-intervention, and 6-month follow-up). The short-term intervention effects were found across domains, including co-parenting conflict, parents' self-compassion, dysfunctional parenting, parenting self-efficacy, parental adjustment, child behavioral problems and child prosocial behaviors. Intervention effects on co-parenting conflict, parenting behaviors, and the child's prosocial behaviors were maintained at a 6-month follow-up. This study demonstrates the efficacy of Triple P plus compassion in promoting co-parenting relationships between parents and grandparents, enhancing parenting practice and child outcomes in Vietnamese families.     

Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder

The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2–6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.     

Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents' interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents' preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents' ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3-6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents' ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

Sibling Relationships in Emerging Adulthood: Associations with Parent–Child Relationship

Conflicting theories (e.g., compensatory and congruence) describe the effect of the parent–child relationship on sibling relationship quality. By identifying specific parenting factors (i.e., Care and Control) and specific aspects of the sibling relationship (i.e., Affect, Behaviors, and Cognitions), the current study sought to examine the factors related to either theory in order to better understand the sibling relationship in emerging adulthood. Data were collected from 575 undergraduate students. A factorial MANOVA tested the relationship between parenting style and sibling relationship quality, measured by the Lifespan Sibling Relationship Scale. Results primarily supported the congruence hypothesis and revealed that parental Care and Control are important variables in understanding the sibling relationship. Additionally, the findings were consistent across racial/ethnic groups.     

Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior,Parenting Style,and Parental Adjustment: An Intervention Study in Japan

The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children’s behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of both the intervention and control groups (N = 91 and N = 24, respectively) were recruited from mothers visiting health clinics in Kawasaki City, Kanagawa. Intervention and control groups were assessed in terms of child behavior (Strength and Difficulty Questionnaire, SDQ), parenting style (Parenting Scale, PS), and parenting adjustment (Depression-Anxiety-Stress Scale, DASS; and Parenting Experience Survey, PES), both pre- and postintervention. A repeated measures multivariate analysis of variance was used to determine the intervention’s effects. The SDQ score for the conduct problems subscale indicated a significant intervention effect. In addition, the postintervention scores for all subscales of the PS, the DASS depression subscale and total scores, as well as ratings for perceived difficulty of parenting in the PES, were significantly reduced in the intervention group alone. The PES also revealed that confidence in parenting significantly increased only in the intervention group. Group Triple P is effective in decreasing child conduct problems, dysfunctional parenting practices, depression, anxiety, stress, and the perceived level of parenting difficulty, as well as in improving parenting confidence, among Japanese families.     

An evaluation of a behavioural parenting intervention for parents of gifted children

Parents of gifted children identify a need for tailored parenting support, and gifted children have unique requirements and vulnerabilities. The aim of this study was to assess the efficacy of a tailored behavioural parenting intervention, for enhancing the parenting skills of parents of gifted children and to assess the effect of these changes on the behavioural and emotional adjustment of their gifted child. A randomised controlled trial of tailored Group Triple P – Positive Parenting Program was conducted with 75 parents of children identified as gifted. Results indicated significant intervention effects for the number and frequency of parent reported child behaviour problems, as well as hyperactivity in the intervention group, relative to a waitlist control. Parents also reported significant improvements in their own parenting style, including less permissiveness, harshness, and verbosity when disciplining their child. No intervention effects were evident for teacher reports, except for a trend in relation to hyperactivity. This study demonstrated that a tailored behavioural parenting intervention is effective and acceptable for parents of gifted children, and thus has clinical implications for the delivery of parenting interventions for this population.