The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions

Exposure to neighborhood violence, self-efficacy, and child maltreatment

BACKGROUND

Child maltreatment is a significant public health concern in the United States, with long-lasting consequences for children's development. Exposure to community violence is a known risk factor for child maltreatment, yet the mechanisms underlying this relationship are unclear. Self-efficacy, a construct reflecting an individual's perceived ability to influence their environment, may play a critical mediating role in this pathway.

OBJECTIVE

This study aimed to investigate whether self-efficacy mediates the relationship between exposure to community violence and child maltreatment, including physical assault, psychological aggression, and neglect.

PARTICIPANTS AND SETTING

Data were drawn from the Future of Families and Child Wellbeing Study, a longitudinal study of 4898 children born in 20 major cities in the United States. The analysis focused on the third wave of data when children were age 3.

METHODS

Structural equation modeling was employed to assess the direct and indirect effects of exposure to community violence on three forms of child maltreatment through the mediating variable of self-efficacy.

RESULTS

Exposure to community violence had a direct negative impact on maternal self-efficacy. In turn, higher self-efficacy was protective against all three forms of child maltreatment. Self-efficacy partially mediated the relationship between exposure to community violence and child maltreatment, highlighting a pathway through which exposure to violence affects parenting behaviors.

CONCLUSIONS

Findings underscore the importance of self-efficacy as a protective pathway in mitigating the effects of community violence on child maltreatment. Interventions aimed at enhancing parental self-efficacy and reducing community violence may have significant implications for preventing child maltreatment.

Parent Attachment and Video Gaming Addiction: The Serial Mediation Role of Social Support and Maladaptive Daydreaming

Previous research has demonstrated both direct and indirect relationships between parental attachment and gaming addiction in adolescents. This study aimed to investigate the role of parental attachment in adolescent gaming addiction, specifically examining how maladaptive daydreaming and perceived social support function as mediators in this relationship. A convenience sample of 898 Italian adolescents (550 female, Mage = 14.89 years, SD = 1.71) completed a questionnaire that included the Inventory of Parent and Peers Attachment, the Maladaptive Daydreaming Scale, the Game Addiction Scale, and a demographic survey. Correlation analyses confirmed a negative relationship between parental attachment and gaming addiction. Mediation analyses also showed that perceived social support and maladaptive daydreaming serve as significant serial mediators in this relationship. These results emphasize the importance of both factors in understanding how parental attachment influences gaming addiction. Adolescents exhibiting gaming addiction is caused by low perceived social support and maladaptive daydreaming may benefit from psychological interventions targeting adaptive regulation strategies. Strengthening the sense of security and self-confidence through such interventions may help to reduce excessive gaming behaviors.

Parenting style patterns and their longitudinal impact on mental health in abused and nonabused adolescents

Background

While the impact of parenting styles on adolescents' mental health is well documented, no study has used latent person-oriented methods to analyze the effects of parenting style trajectories, experienced by physically abused and nonabused adolescents from early to middle adolescence, on mental health outcomes.

Method

In this longitudinal study, we used latent transition analysis (LTA) to detect parenting patterns and their trajectories among 1,709 adolescents from 44 high schools in Switzerland across three data waves (2021-2023) by applying a multigroup comparison between physically nonabused and abused adolescents. Using multinomial regression, we tested the effects of the detected parenting patterns on adolescents' mental health.

Results

Along with the two known patterns, termed "supportive" and "negative" parenting, two new parenting patterns which we termed "absent" (low levels on all tested parenting styles) and "ambiguous" (middle to high levels on all tested parenting styles) emerged as playing a key role in the perceptions of adolescents with and without parental abuse experience longitudinally. These four patterns developed in diverse ways: Supportive parenting decreased for abused adolescents over time but remained stable for the nonabused adolescents. The absent parenting level was stable over time among abused adolescents when compared to the outcomes experienced by adolescents subjected to the negative parenting pattern. Furthermore, we found a remarkable decline in the number of nonabused adolescents in the absence pattern from Wave 1 to Wave 3. Further, we also found that abused adolescents reported more negative parenting than nonabused adolescents. Additionally, we found that supportive parenting was beneficial for adolescents' mental health whereas negative, ambiguous, and absent parenting all had detrimental effects.

Conclusions

These findings highlight the beneficial association of supportive parenting and the detrimental effects of negative, ambiguous, and absent parenting. This also suggests that we must consider a more complex approach that involves examining a blend of different parenting styles when analyzing adolescent mental health.

Finding Solutions to Scaling Parenting Programs That Work: a Systems-Contextual Approach

Prevention science has now encompassed decades of research exploring risk and protective factors and effective programs for the prevention and treatment of childhood behavioral, emotional, and developmental concerns. This paper shares our experience over the last 40 years as program developers and researchers in responding to contemporary needs and finding solutions to barriers preventing access to evidence-based parenting support. We propose a systems-contextual approach to designing and implementing programs that meet families' needs and preferences and promote self-regulatory capacity across the lifespan. Key areas discussed are innovations to improve the reach of evidence-based parenting support (e.g., online program delivery, cultural adaptation, and tailored programs to engage vulnerable children and families), innovations to improve professional training outcomes (e.g., competency-based training, peer supervision and support, implementation support, and workforce development), and innovations to meet future needs (e.g., embracing new technology, standing by science, and considering global issues). It is incumbent on program developers, researchers, and clinicians to continue to evolve our practices and service systems in response to new evidence, societal changes, and technical advances to remain relevant and impactful in shifting prevalence rates of conduct problems and promoting child, family, and community well-being.

Family Check-Up Online effects on parenting and parent wellbeing in families of toddler to preschool-age children

Online parenting interventions hold promise for increasing access to behavioral support for families with low income and who reside in rural areas. The current study evaluates the efficacy of a mobile app-based parenting support program, the Family Check-Up Online (FCU-O) with telehealth coaching support, for parents of children 1.5-5 years old at risk of experiencing parenting challenges. We tested effects of the FCU-O on parent wellbeing (parenting self-efficacy and symptoms of depression and anxiety) and parent-reported parenting skills (support for positive behavior, limit-setting, and proactive parenting) at the 3-month follow-up in a randomized controlled trial (FCU-O versus control). We also tested relationships between parents' baseline characteristics and their engagement with the app and telehealth coaching. Eligibility criteria included endorsing depressive symptoms or current or past substance misuse. Participants (N = 356) were predominantly White (72%) and low-income, with 43% of families residing in a rural area. Approximately one third of participants reported clinically significant symptoms of anxiety or depression and one third endorsed a lifetime history of opioid misuse. Intent to treat analyses tested effects of the FCU-O on parent wellbeing and parenting skills. The FCU-O was associated with improvements to parents' support for positive behavior, limit-setting, and proactive parenting skills, as well as parenting self-efficacy and depressive symptoms. Parents' initial symptoms of depression and anxiety significantly predicted greater telehealth coach engagement; low levels of initial self-reported skills positive behavior support and limit-setting significantly predicted greater app engagement. Results provide support for the FCU-O as a preventive parenting intervention for parents experiencing mental health challenges, with implications for reducing barriers to accessing parenting support for underserved families.

Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs)

A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating the presentation of irritability in young people with ND-CNVs. This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ). Irritability and broader psychopathology were assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment. Autism was assessed using the social communication questionnaire, and intelligence quotient (IQ) by the Wechsler abbreviated scale of intelligence. Fifty four percent of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p = 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ. Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.

Play Well Triple P: Developing and Evaluating a Program to Promote Positive Parental Involvement in Junior Sport

Parents play a central role in children's ongoing participation and enjoyment of sport. Despite compelling evidence that parental behaviour can undermine the quality of children's experiences in sport, little research has examined whether strategies to support parents to engage in positive sports parenting behaviour are effective. In this paper, we report two studies that had the overall aim of developing, implementing and evaluating a program designed to promote positive parental involvement and improve spectator behaviour in junior rugby league in Australia. Study 1 involved the development of a prototype version of the program, named Play Well Triple P, which was qualitatively evaluated through interviews with 19 parents about their satisfaction with the program. In Study 2, we used feedback from Study 1 to refine the program and develop a pilot version, which was then evaluated in a quasi-experimental feasibility study with 101 parents (mean age = 38.42 years; 72% mothers) of junior rugby league players. The pilot version involved one interactive online module and text messages to reinforce content and prompt strategy implementation across the season. Participation in Play Well Triple P was associated with increased positive sports parenting behaviour and reduced controlling and intrusive sports parenting behaviour, with a trend towards reducing over-reactive parenting practices at home. These findings are discussed in relation to the feasibility of implementing a brief and engaging sports parenting intervention in the context of a broader integrated system designed to facilitate ongoing participation of children in sport.

Brief parenting intervention (Triple P) for families of children with eczema: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema.

METHODS

A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated.

RESULTS

Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159.

CONCLUSIONS

Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life.

CLINICAL TRIAL REGISTRATION

ACTRN12618001332213.

The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis

Violence has immediate and long-term repercussions for the health of individuals and communities. Recent increases in the understanding of public health approaches to violence prevention have focused on the policies and practices of government, health, and other public sector agencies. However, the roles of commercial bodies in fostering and preventing violence remain largely unaddressed. The wealth and influence of some companies now exceeds that of many countries. Consequently, it is timely to explore the roles of commercial processes in violence. Using a conceptual framework for the commercial determinants of health, we examine seven practices: political; scientific; marketing; supply chain and waste; labor and employment; financial; and reputational management. We include areas directly linked with violence (e.g., firearms) and those that indirectly impact violence through the following: design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. A range of avoidable commercial behaviors are found to increase levels of violence including the following: lobbying practices; distortion of scientific processes; polluting manufacture and supply lines; poor employee protections; financial investment in organizations and regimes associated with violence; and misleading communications and marketing. We conclude commercial actors can take action to ensure their workers, clients, suppliers, and distributors help prevent, not promote, violence. New technologies such as artificial intelligence are transforming corporate processes and products and offer opportunities to implement violence prevention through commercial developments (e.g., monitoring online content). International regulation of commercial behaviors is needed to prevent interpersonal and interstate conflict and harms to health and trade.

Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs)

Background

A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating presentation of irritability in young people with ND-CNVs.

Aims

This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ).

Methods

Irritability and broader psychopathology was assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment (CAPA). Autism was assessed using the Social Communication Questionnaire (SCQ), and Intelligence Quotient (IQ) by the Wechsler Abbreviated Scale of Intelligence (WASI).

Results

54% of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p= 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ.

Conclusions

Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.

The thriving kids and parents schools project: protocol of an incomplete stepped wedged cluster randomised trial evaluating the effectiveness of a Triple P seminar series

BACKGROUND

The COVID-19 pandemic disrupted the normality of daily life for many children, their families, and schools, resulting in heightened levels of anxiety, depression, social isolation, and loneliness among young people. An integrated public health model of interventions is needed to address the problem and to safeguard the mental health and wellbeing of children. The Triple P - Positive Parenting Program is one system of parenting support with a strong evidence-base and wide international reach. When implemented as a public health approach, Triple P has demonstrated population level positive effects on child wellbeing. This study will be the first large-scale, multi-site randomised controlled trial of a newly developed, low-intensity variant of Triple P, a school-based seminar series, as a response to the impacts of the pandemic.

METHODS

The evaluation will employ an Incomplete Batched Stepped Wedge Cluster Randomised Trial Design. At least 300 Australian primary schools, from South Australia, Queensland, and Victoria will be recruited and randomised in three batches. Within each batch, schools will be randomly assigned to either start the intervention immediately or start in six weeks. Parents will be recruited from participating schools. The Triple P seminar series includes three seminars titled: "The Power of Positive Parenting", "Helping Your Child to Manage Anxiety", and "Keeping your Child Safe from Bullying". Parents will complete measures about child wellbeing, parenting, parenting self-regulation and other key intervention targets at baseline, six weeks after baseline, and 12 weeks after baseline. Intervention effectiveness will be evaluated with a Multilevel Piecewise Latent Growth Curve Modelling approach. Data collection is currently underway, and the current phase of the project is anticipated to be completed in January 2024.

DISCUSSION

The findings from this study will extend the current knowledge of the effects of evidence-based parenting support delivered through brief, universally offered, low intensity, school-based parenting seminars in a post pandemic world.

TRIAL REGISTRATION

The trial is registered at the Australian New Zealand Clinical Trials Registry (Trial Registration Number: ACTRN12623000852651).