Using household survey data to inform policy decisions regarding the delivery of evidence-based parenting interventions

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

Triple P is an integrated, multi-level system of evidence-based parenting support designed to promote the well-being of children and families to reduce prevalence rates of social, emotional, and behavioral problems in children and adolescents and to prevent child maltreatment. The system developed gradually over four decades to address the complex needs of parents and children from diverse family, socioeconomic and cultural backgrounds. It blends universal and targeted programs, a focus on developing parental self-regulation capabilities, and adopts a life span perspective with a population health framework. The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention. Seven stages of program development are outlined from initial theory building and development of the core parenting program through to the sustained deployment of the intervention system delivered at scale. The importance of ongoing research and evaluation is highlighted so that different programs within the system evolve and adapt to address the contemporary concerns and priorities of families in diverse cultural contexts. A well-trained workforce is essential to deliver evidence-based programs, in a need-responsive manner that blends both fidelity of delivery and flexibility and is tailored to respond to the needs of individual families and local context. Programs need to be gender-sensitive, culturally informed, and attuned to the local context including relevant policies, resources, cultural factors, funding, workforce availability and their capacity to implement programs.

Toward evidence-informed child rearing: Measurement of time-out implementation in a community sample

BACKGROUND

Time-out (TO) is a widely used parental discipline strategy with strong research support in programmes that promote positive child development. Concerns have been raised, however, regarding adverse impact on child mental health (CMH) in part driven by evidence of widespread variability in appropriate implementation. There are no existing measures of TO. We present the first measure of procedural implementation of TO in a community sample of parents of children aged 6-8 years.

METHODS

A nationally representative sample (N = 474) of parents completed a survey on the implementation of TO, parent-child relationships, and emotional and behavioural difficulties. The scale of TO use was used to test the convergent validity between TO implementation and parenting practices/family adjustment and CMH.

RESULTS

Consistent with international research, >70% of parents have used TO with their children. There was high variability in the levels of appropriate implementation of TO. Scale reliability (Cronbach's alpha) was acceptable and tests of convergent validity indicated that as expected, less appropriate implementation of TO was associated with worse CMH and poorer parenting and family adjustment.

CONCLUSIONS

The current findings suggest that the scale is a psychometrically sound instrument for measuring the appropriate procedural implementation of TO with young children.

An Updated Account on Parents' Use of and Attitudes Towards Time-Out

Time-out (TO) is a well-established technique for effectively managing childhood conduct problems, yet there is increasing controversy around its use. Using a mixed-methods approach, we investigated the impact of recent criticisms against TO on parents' use of and attitudes towards it. A community sample of parents (N = 297, M_age = 37.14) completed an online survey (Study 1) to investigate use of and acceptability of TO. Results showed that 57.91% of parents reported using TO, slightly lower than past estimates. Perceived effectiveness and trust in clinicians predicted TO acceptability. To thoroughly examine negative attitudes towards TO, parents who did not use TO (N = 17, M_age = 38.29) participated in individual interviews (Study 2). Amongst other findings, Study 2 found that parents view TO as punitive and contrary to their value of connection. We discuss implications for parenting interventions, dissemination of parenting information, and future research.

The Triple P Positive Parenting Program for Parents With Psychosis: A Case Series With Qualitative Evaluation

Although many people with psychosis are parents, managing the dual demands of poor mental health and parenting can be stressful and may contribute to poorer outcomes for both parent and child. Parenting interventions have the potential to improve outcomes for the whole family but need evaluation of feasibility in this context. The Triple-P Self-Help Workbook was implemented with guidance and support with 10 parents experiencing psychosis in a multiple baseline case series study. Sessions were weekly and home-based. Outcome measures examined facets of parenting, child behavior, self-efficacy and parental mental health. Follow up interviews explored parents' perspectives of the perceived impact of the intervention and apparent mechanisms of change. The program resulted in clinically significant change (>25% improvement) in mental health, parenting and child behavior measures post-intervention for the 50% who completed all 10 sessions and improvements were maintained at 3 and 6 month follow up. Interviews with those who completed the program revealed it to have been transformative: parents reported positive changes in parenting style; they were empowered with regard to their parenting and had a greater sense of control over their mental health. This study provides preliminary evidence that self-directed Triple P might be able to reduce the symptoms of psychosis by improving family functioning. Findings could inform the future development or adaptation of evidence-based parenting interventions for parents with psychosis in order to improve their mental health, aid recovery, and intervene early in the lives of children at risk of poor long-term outcomes.

Parental Cognitions and Motivation to Engage in Psychological Interventions: A Systematic Review

This paper reviews the available research on the predictors of parental engagement in preventive and therapeutic psychological interventions that target mental health problems in children. Based on previous literature, seven predictors concerning parental motivation to engage are considered: perceived child problems, perceived parenting, attributions of problems, self-efficacy, expectations about treatment, perceived obstacles and global motivation to engage. PRISMA guidelines for systematic review were used to conduct the literature search. Thirty-seven studies that examined prospective relations between parental cognitions evaluated at the beginning of the intervention and parental engagement during the intervention were included. Most studies focused on the parents' perception of the child's problems and of parenting, with fewer studies examining the role of the other parental cognitions. The results suggest that the psychological dimensions proposed in motivational models may play an important role in understanding parental engagement in preventive and therapeutic psychological interventions.

Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

The Grow parenting program: demonstrating proof of concept

Purpose

Parent-focused interventions (PFIs) are a promising method for supporting parents and promoting children’s well-being. Few PFIs in the USA, however, include physical health promotion content and are universal programs. The purpose of this paper is to describe a universal health-promoting PFI for parents of elementary school-aged children and demonstrate proof of concept.

Design/methodology/approach

The program emphasizes positive parenting practices, stress management skills and physical health promotion strategies and recommendations, and is part of a larger initiative that includes a continuum of universal, developmentally appropriate, health-promoting PFIs for civilian and military parents. The program was implemented at two community sites in rural Pennsylvania with 20 civilian parents completing pretests and posttests. Study measures assessed parenting, stress and stress management and physical health promotion related outcomes.

Findings

Parents reported decreases in suboptimal discipline and feeding practices, stress and child internalizing behavior. They also reported increases in their sense of control in managing child behavior, coping socialization, child’s outdoor playtime and health recommendations met.

Research limitations/implications

While these preliminary findings may not be generalizable, they serve as proof of concept, which suggests that more rigorous research on the program is warranted.

Practical implications

Implementing a universal, health-promoting PFI within the USA is viable and has the potential to impact multiple short-term outcomes.

Originality/value

Parents are among their child’s earliest and most influential educators, and this study lends further support to their role as health educators. Given the significant public health benefits of holistically promoting child health, the time has come for universal PFIs to begin including physical health promotion content.

The International Parenting Survey: Rationale, Development, and Potential Applications

The quality of parent-child interactions and family relationships has a powerful influence on children's development and well-being. The International Parenting Survey (IPS) is a brief, web-based survey developed to provide a cross-national, community-level, population snapshot of the experiences of parents related to raising children. The IPS was developed as a planning tool to assist policy makers and community agencies plan, implement, and evaluate parenting programs and as a tracking tool to evaluate parenting support programs in different countries. We report the preliminary psychometric properties of the IPS on various domains of measurement in an international sample of over 9,000 parents. Moderate to high reliabilities were obtained for all domains of measurement. High internal consistency reliabilities (α = .88-.97) were obtained for the domains of children's behavior and emotional maladjustment, for parental self-efficacy, parental distress and parental beliefs. Moderate levels of reliabilities (α = .52-.83) were obtained for domains of parental consistency, coercive parenting, positive encouragements, and parent-child relationships. Overall, the measure appears to have satisfactory reliability justifying further psychometric validation studies in population level studies of parenting. Examples of uses of the IPS are described and directions for future research and policy explored.

Evidence-based guidance to assist volunteers working with at-risk children in a school context

AIM

One of the activities of the Belgian Red Cross is the 'Bridging the Gap' project, in collaboration with local schools. In this project, volunteers join the teaching staff to improve personal development goals in at-risk children with poor performance. The aim of this study was to develop evidence-based guidance for the volunteers to help them choose the right didactical approach for supporting these children.

METHOD

Systematic literature searches were performed in three bibliographic databases (the Campbell Library, MEDLINE and ERIC) to find the effectiveness of 16 different didactical activities. In addition, during a consensus meeting with relevant stakeholders, we discussed the applicability and meaningfulness of these activities for volunteers in the school context.

RESULTS

We identified 38 relevant studies out of 12 056 references. Evidence of effectiveness was available for the following activities: book reading, road-safety education, number games, puzzle making, singing, block-building activities, reading poetry, computer-assisted instruction, storyboards, role play and a library visit. Based on the discussion with stakeholders, we developed evidence-based guidance with recommendations and suggestions to assist volunteers in their task.

CONCLUSION

This evidence-based guidance was developed to help volunteers working in a school context to choose which didactical activities to carry out with at-risk children, with the aim of improving the children's personal development. The list of didactical approaches we promote is not exhaustive and will most likely continue to grow, as many activities are currently not (well) described in scientific studies. In addition, contextual factors that may play a role in the success or failure of certain didactical activities are also subject to change.

[Validation of the French Version of Parental Multidimensional Neglectful Behavior Scale]

OBJECTIVE:

Measuring parental neglect is challenging on many levels and few tools exist that are able to document it with parents. This study aims to document the psychometric properties in the French version of the population-based Multidimensional Neglectful Behavior Scale, short version.

METHOD:

This study uses data from a telephone survey conducted with a representative sample of 3584 mothers and 1202 fathers of children aged between 6 months and 4 years old, 5 and 9 years old, and 10 and 15 years old. Associations are made between neglect and several other factors known to be linked to this issue, including violent parental behaviors, stress associated with the child perceived difficult temper and work-family balance, alcohol and drug use, depression symptoms, poverty, and social support.

RESULTS:

Exploratory factor analysis show the presence of different neglect dimensions relating to the children affective/cognitive, physical (basic care) and supervision needs. Although these dimensions are closely associated with the children and families’ psychosocial vulnerability factors, internal consistency coefficients are low, ranging from 0.20 to 0.64.

CONCLUSION:

Recommendations are made to improve measure in general population, including the parental supervision dimension which is particularly challenging.

A randomized controlled trial evaluating a low-intensity interactive online parenting intervention, Triple P Online Brief, with parents of children with early onset conduct problems

OBJECTIVE

This randomized controlled trial examined the efficacy of Triple P Online Brief, a low-intensity online positive parenting program for parents of children with early onset disruptive behavior problems.

METHOD

Two hundred parents with 2-9-year-old children displaying early onset disruptive behavior difficulties were randomly assigned to either the intervention condition (n = 100) or a Waitlist Control group (n = 100).

RESULTS

At 8-week post-assessment, parents in the intervention group displayed significantly less use of ineffective parenting strategies and significantly more confidence in dealing with a range of behavior concerns. These effects were maintained at 9-month follow-up assessment. A delayed effect was found for child behavior problems, with parents in the intervention group reporting significantly fewer and less frequent child behavior problems at follow-up, but not at post-assessment. All effect sizes were in the small to medium range. There were no significant improvements in observed negative parent and child behavior. No change was seen for parents' adjustment, anger, or conflict over parenting. Consumer satisfaction ratings for the program were high.

CONCLUSIONS

A brief, low-intensity parenting program delivered via the Internet can bring about significant improvements in parenting and child behavior.

Reducing Child Maltreatment by Making Parenting Programs Available to All Parents: A Case Example Using the Triple P-Positive Parenting Program

Preventing the maltreatment of children is a major public health challenge. Using the Triple P-Positive Parenting program as an example, this article makes the case that strengthening parenting and family relationships at a population level is a potentially powerful means of taking on this challenge. We focus on the value of making parenting programs available to all parents in the community. We conclude by examining the key ingredients required to make a population-level parenting approach to reducing child maltreatment work.

Dealing with Disobedience: An Evaluation of a Brief Parenting Intervention for Young Children Showing Noncompliant Behavior Problems

The study was a randomized controlled trial evaluating the efficacy of a brief and preventatively-focused parenting discussion group for dealing with disobedient behavior in preschool-aged children. Eighty-five parents with children aged between 3 and 5 years who were concerned about the noncompliant behavior of their child were recruited from Auckland, New Zealand and Brisbane, Australia. Compared to the waitlist control group (n = 40), parents in the intervention group (n = 45) reported greater improvements in disruptive child behavior, ineffective parenting practices and parenting confidence, as well as clinically significant improvements in child behavior and parenting. All of these effects were maintained at 6-month follow up. No group differences were found for parental wellbeing, inter-parental conflict and general relationship quality, although intervention parents reported improvements in parental wellbeing and inter-parental conflict at 6-month follow-up. The findings are discussed in terms of the implications for making brief and effective parenting support available to parents.

Parent and adolescent effects of a universal group program for the parenting of adolescents

There is growing support for the large-scale implementation of parenting programs for the prevention of child behavior disorders and child maltreatment in younger children. However, there is only limited evidence on the efficacy of parenting programs in modifying risk and protective factors relating to adolescent behavior problems. This study examined the efficacy of Group Teen Triple P (GTTP), an eight-session parenting program specifically designed for parents of young adolescents. Seventy-two families with adolescents aged between 12 and 15 years were randomly assigned to either GTTP (n = 35) or a care as usual (CAU) control condition (n = 37). Compared to CAU parents, parents who received GTTP reported significant improvements in parenting practices, parenting confidence, the quality of family relationships, and fewer adolescent problem behaviors at post-intervention. Several of the parent-reported effects were corroborated by reports from adolescents, including decreases in parent-adolescent conflict and increases in parental monitoring. Adolescents whose parents participated in GTTP also reported significantly fewer behavioral problems than adolescents in the CAU condition. Many of these improvements were maintained at 6-month follow-up.

The acceptability of parenting strategies for grandparents providing care to their grandchildren

Despite the evidence supporting parenting programmes as a pathway to reduce and prevent childhood emotional and behavioural problems, these programmes still have low rates of uptake by families in the community. One way of increasing the participation rates of families in parenting programmes is to adopt a consumer's perspective to programme design and development. This study sought to examine whether grandparents providing regular care to their grandchildren viewed the strategies advocated in a parenting programme developed specifically for them as being acceptable and useful, and whether there were barriers to programme use. Forty-five grandparents, with an average age of 61.4 years (SD = 5.0), participated in the study. Grandparents provided between 11 and 20 h of care per week to their grandchildren, who were on average 4.5 years old (SD = 2.4), with the majority being boys (60%). Results revealed that grandparents found the strategies promoted in the parenting programme highly acceptable and useful and were likely to use the strategies. Barriers to using specific strategies included time demands and belief that a specific strategy would not work. The implications of these findings are discussed within the context of consumer involvement in programme design and development.

A Randomized-Controlled Trial of the Triple P-Positive Parenting Program Seminar Series with Indonesian Parents

There are limited evaluations of an evidence-based parenting program for parents from large developing countries, such as Indonesia. This study aimed to test the efficacy and acceptability of an evidence-based parenting program, the Triple P seminar series, among Indonesian parents. The level of child emotional and behavioral problems was the primary outcome of this study. Participants were 143 parents of children aged 2-12 years in Indonesia that were randomly allocated into the intervention (n = 72) or waitlist control group (n = 71). Participants, investigators, and data collectors were not blinded to the group assignment. A randomized-controlled trial was conducted with 143 parents of children aged 2-12 years in Indonesia. Results showed that parents in the intervention group reported a greater decrease in child behavioral problems (d = 0.45), dysfunctional parenting practices (d = 0.69), parental stress (d = 0.44), and a greater increase in parenting confidence (d = 0.45) in comparison to parents in the waitlist control group at post intervention. The intervention effects were maintained at 6-month follow up for parents in the intervention group. The program was deemed to be culturally appropriate as parents indicated high levels of acceptability and satisfaction with the program content. It is suggested that future studies include families with lower income and employ a more stringent design (e.g., using validated measures, multiple facilitators, and blinding).

The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting support

This systematic review and meta-analysis examined the effects of the multilevel Triple P-Positive Parenting Program system on a broad range of child, parent and family outcomes. Multiple search strategies identified 116 eligible studies conducted over a 33-year period, with 101 studies comprising 16,099 families analyzed quantitatively. Moderator analyses were conducted using structural equation modeling. Risk of bias within and across studies was assessed. Significant short-term effects were found for: children's social, emotional and behavioral outcomes (d=0.473); parenting practices (d=0.578); parenting satisfaction and efficacy (d=0.519); parental adjustment (d=0.340); parental relationship (d=0.225) and child observational data (d=0.501). Significant effects were found for all outcomes at long-term including parent observational data (d=0.249). Moderator analyses found that study approach, study power, Triple P level, and severity of initial child problems produced significant effects in multiple moderator models when controlling for other significant moderators. Several putative moderators did not have significant effects after controlling for other significant moderators. The positive results for each level of the Triple P system provide empirical support for a blending of universal and targeted parenting interventions to promote child, parent and family wellbeing.

An evaluation of the efficacy of a triple P-positive parenting program podcast series

OBJECTIVE

Parenting programs based on cognitive-behavioral and social learning principles are effective in changing child behavior problems and parenting styles. However, such programs typically have limited population reach. The current study aimed to evaluate the efficacy of a brief radio series that provided parenting advice based on the Triple P-Positive Parenting Program.

METHOD

One hundred thirty-nine parents of children aged 2 to 10 years who had concerns about their child's behavioral and/or emotional adjustment were recruited, randomly assigned to either an intervention or waitlist control group, and completed online self-report measures. Parents in the intervention group were given access to seven Triple P podcasts online over a period of 2 weeks.

RESULTS

Parents in the intervention group improved significantly more than parents in the control group, from pre- to postintervention, on measures of child behavioral problems and parenting style, self-efficacy, and confidence. These short-term intervention effects were maintained at the 6-month follow-up.

CONCLUSION

These results suggest that brief radio and online parenting programs can be effective and have the potential to reach a large proportion of parents experiencing child behavior problems. Limitations, clinical significance, and future research suggestions are discussed.

Study protocol: evaluation of a parenting and stress management programme: a randomised controlled trial of Triple P Discussion Groups and Stress Control

BACKGROUND

Children displaying psychosocial problems are at an increased risk of negative developmental outcomes. Parenting practices are closely linked with child development and behaviour, and parenting programmes have been recommended in the treatment of child psychosocial problems. However, parental mental health also needs to be addressed when delivering parenting programmes as it is linked with parenting practices, child outcomes, and treatment outcomes of parenting programmes. This paper describes the protocol of a study examining the effects of a combined intervention of a parenting programme and a cognitive behavioural intervention for mental health problems.

METHODS/DESIGN

The effects of a combined intervention of Triple P Discussion Groups and Stress Control will be examined using a randomised controlled trial design. Parents with a child aged 3-8 years will be recruited to take part in the study. After obtaining informed consent and pre-intervention measures, participants will be randomly assigned to either an intervention or a waitlist condition. The two primary outcomes for this study are change in dysfunctional/ineffective parenting practices and change in symptoms of depression, anxiety, and stress. Secondary outcomes are child behaviour problems, parenting experiences, parental self-efficacy, family relationships, and positive parental mental health. Demographic information, participant satisfaction with the intervention, and treatment fidelity data will also be collected. Data will be collected at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up.

DISCUSSION

The aim of this paper is to describe the study protocol of a randomised controlled trial evaluating the effects of a combined intervention of Triple P Discussion Groups and Stress Control in comparison to a waitlist condition. This study is important because it will provide evidence about the effects of this combined intervention for parents with 3-8 year old children. The results of the study could be used to inform policy about parenting support and support for parents with mental health problems.

TRIAL REGISTRATION

ClinicalTrial.gov: NCT01777724, UTN: U1111-1137-1053.

An analysis of two evidence-based parent training programmes and determination of the characteristics for a new programme model

The Triple P and Incredible Years are the two best (well-known) parent programmes which cooperate with families and the society, reduce the risk factors and support the protective factors. The programmes also offer a multidisciplinary approach with high evidence standards, use randomized controlled studies and yield long-term results. Accordingly, this literature review was conducted in order to evaluate the efficacy of these two programmes, to determine the (similarities) and differences. 'MEDLINE, PUBMED, COCHRANE' databases, online and published journals and dissertations in Turkey were reviewed for the study. Consequently, results of 49 studies were presented, which were evaluated according to certain criteria such as samples, methods and results. The studies on the Triple P and the Incredible Years Parent Program illustrated a decrease in problematic behaviours of the children and negative parenting practices of parents following the implementation of programmes. However, the studies also pointed out the differences between the Triple P and the Incredible Years Parent Program. It is recommended that a new parent education programme be prepared and tested for our country in accordance with the results of the study.

A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems

OBJECTIVE

This study examined the efficacy of Triple P Online (TPOL), an eight-module intensive online positive parenting program for parents of children with early-onset disruptive behavior problems.

METHOD

One hundred and sixteen parents with 2-9-year-old children displaying early-onset disruptive behavior difficulties were randomly assigned to either the intervention condition (N = 60) or an internet-use-as-usual control group (N = 56).

RESULTS

At post-intervention assessment, parents receiving the internet intervention TPOL had significantly better outcomes on measures of problem child behavior, dysfunctional parenting styles, parents' confidence in their parenting role, and parental anger. At 6-month follow-up assessment intervention gains were generally maintained, and in some cases enhanced. Consumer satisfaction ratings for the program were high.

CONCLUSIONS

Internet-delivered self-help parenting programs appear to make a valuable contribution to a comprehensive public health approach to parenting support.

Using Consumer Input to Tailor Evidence-Based Parenting Interventions to the Needs of Grandparents

Grandparents provide a significant amount of child care to their grandchildren. However, there is limited research investigating whether grandparents would view a parenting program developed specifically for them as useful. Our study adopted a consumer focused perspective to program design and examined the challenges encountered by grandparents in their role as an informal child care provider. Focus groups were conducted with fourteen grandparents (11 females, 3 males) aged 45-76 years (M = 60.14) the majority of whom provided 11-20 h of care per week to their grandchild. A thematic analysis indicated that grandparents have difficulty managing the relationship with the parents and remembering effective parenting strategies. In addition, grandparents also indicated wanting further strategies to cope with the stressors associated with the role, particularly surrounding feelings of frustration and guilt. These results suggest that grandparents could benefit from a parenting program and this paper argues that an existing evidence-based parenting program should be modified. In terms of implications for program design the inclusion of a module centered on improving grandparent-parent communication and partner support may buffer potential conflict and tension that can arise in co-parenting situations.

Consumer engagement and the development, evaluation, and dissemination of evidence-based parenting programs

A consumer perspective can contribute much to enhancing the "ecological fit" of population-level parenting interventions so they meet the needs of parents. This approach involves building relationships with consumer groups and soliciting consumer input into the relevance and acceptability of interventions, clarifying the enablers and barriers to engagement and involvement of parents, and clarifying variables that influence a parent's program completion. The adoption of a more collaborative approach to working with consumers is important if meaningful population-level change in the prevalence of serious social, emotional, and behavioral problems in children and young people is to be achieved. Parents seeking assistance for their children's behavior come from a diverse range of socioeconomic backgrounds, educational levels, cultures, and languages. This paper examines consumer engagement strategies that can be employed throughout the process of program development, evaluation, training, and dissemination, and in "scaling up" the intervention. We argue that a multilevel public health approach to parenting intervention requires a strong consumer perspective to enable interventions to be more responsive to the preferences and needs of families and to ensure improved population reach of interventions. Examples from large-scale dissemination trials are used to illustrate how consumer input can result in an increasingly differentiated suite of evidence-based parenting programs.

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.

An epidemiological examination of parenting and family correlates of emotional problems in young children

The present article used data from a community sample of primary caregivers of children between 4 and 7 years old to investigate the prevalence and correlates of emotional symptoms in young children transitioning to elementary school. Mothers (n = 3,483) and fathers (n = 1,019) living in metropolitan areas of eastern Australia participated in a telephone survey of parenting practices and child behavioral and emotional problems. Fifteen percent of mothers and 12% of fathers reported that their child showed clinically elevated levels of emotional symptoms. The most common parental responses to a child's anxious or distressed behavior were to use physical contact, talk in a soothing voice, or encourage their child to be brave, while fewer than 10% of parents ignored their child's distress by not giving any attention. For mothers, reports of child emotional symptoms were associated with mothers' use of physical contact to soothe their children, mothers' level of personal stress and depression, their confidence in managing anxious or distressed behavior, and consistency in their application of discipline. Fathers' encouragement of their children to be brave and fathers' confidence in managing anxious or distressed behavior were associated with reduced child emotional symptoms. These findings have implications for the development of universal prevention programs for internalizing disorders in children.

Do testimonials improve parental perceptions and participation in parenting programmes? Results of two studies

Despite the effectiveness of parenting interventions in both prevention and intervention with child emotional and behavioural problems, parental participation in evidence-based programmes remains low, limiting the benefit to the population. This research examines a new population parental engagement strategy for parenting programmes using video testimonials via two studies. The first study compared the use of parent versus expert testimonials, against a no testimonial condition on parenting programme evaluations with 70 parents. The second study compared expert testimonials which were framed in a fear or non-fear context, with 73 parents. Results indicated no significant effect of source of testimonial or content of testimonial on parental evaluations of the programme or behavioural outcomes. Trends favoured expert testimonials over parent testimonials. Implications for population level engagement strategies are discussed.

What are the parenting experiences of fathers? The use of household survey data to inform decisions about the delivery of evidence-based parenting interventions to fathers

Participants were 933 fathers participating in a large-scale household survey of parenting practices in Queensland Australia. Although the majority of fathers reported having few problems with their children, a significant minority reported behavioral and emotional problems and 5% reported that their child showed a potentially problematic level of oppositional and defiant behavior. Reports of child problems were associated with fathers' levels of personal stress and socioeconomic disadvantage. Approximately half of all fathers reported the use of one or more coercive parenting strategies (shouting and yelling, hitting the child with their hand or with an object) with fathers' use of hitting being associated with child behavior difficulties. Fathers reported low rates of help seeking or participation in parenting courses, with socially disadvantaged fathers being less likely to complete parenting programs than other fathers. Implications for research on increasing fathers' participation rates in parenting programs are discussed and directions for future research highlighted.

Population-based prevention of child maltreatment: the U.S. Triple p system population trial

The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P-Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.

Every family: a population approach to reducing behavioral and emotional problems in children making the transition to school

A large-scale population trial using the Triple P-Positive Parenting Program (TPS) was evaluated. The target population was all parents of 4- to 7-year-old children residing in ten geographical catchment areas in Brisbane (intervention communities) and ten sociodemographically matched catchment areas from Sydney (5) and Melbourne (5), care as usual (CAU) comparison communities. All five levels of the Triple P multilevel system of intervention were employed; including a local mass media strategy, a primary care strategy, and three more intensive levels of parenting intervention delivered by a range of service providers (e.g., health, education, and welfare sectors). Program outcomes were assessed through a computer-assisted telephone interview of a random sample of households (N = 3000) in each community at pre-intervention and again at two years post-intervention. At post-intervention there were significantly greater reductions in the TPS communities in the number of children with clinically elevated and borderline behavioral and emotional problems compared to the CAU communities. Similarly parents reported a greater reduction in the prevalence of depression, stress and coercive parenting. Findings show the feasibility of targeting dysfunctional parenting practices in a cost-effective manner and the public acceptance of an approach that blends universal and targeted program elements. Editors' Strategic Implications: This is the first positive parenting program to demonstrate longitudinal, population-level effects for parents and children. The authors provide an excellent example of multilevel prevention planning, coordination, execution, and evaluation.

Can technology and the media help reduce dysfunctional parenting and increase engagement with preventative parenting interventions?

In an evaluation of the television series "Driving Mum and Dad Mad," 723 families participated and were randomly assigned to either a standard or technology enhanced viewing condition (included additional Web-support). Parents in both conditions reported significant improvements from pre- to postintervention in their child's behavior, dysfunctional parenting, parental anger, depression, and self-efficacy. Short-term improvements were maintained at 6-months follow-up. Regressions identified predictors of program outcomes and level of involvement. Parents who watched the entire series had more severe problems at preintervention and high sociodemographic risk than parents who did not watch the entire series. Few sociodemographic, child, or parent variables assessed at preintervention predicted program outcomes or program engagement, suggesting that a wide range of parents from diverse socioeconomic status benefited from the program. Media interventions depicting evidence-based parenting programs may be a useful means of reaching hard to engage families in population-level child maltreatment prevention programs.

"The Costs of a Public Health Infrastructure for Delivering Parenting and Family Support"

OBJECTIVES

To estimate the costs of building a public health infrastructure for delivering a population-wide evidence-based multi-level system of parenting interventions to strengthen parenting; reduce risk for child maltreatment and coercive parenting practices; and reduce the prevalence of early child behavioral and emotional problems.

METHODS

Using data from 9 South Carolina counties, this study examines the costs to service agencies of training a wide range of providers. Using data on the number of children and families served, the paper estimates the total costs of training providers sufficient to treat all children and families in a hypothetical community.

RESULTS

The costs of the universal media and communication component totaled less than $1.00 per child in the population. The costs of training service providers to deliver at other intervention levels were quite modest ($11.74 on a per child basis).

CONCLUSIONS

This study shows that a population-wide system of efficacious parenting programs aimed at reducing child behavioral and emotional problems and promoting effective parenting is quite feasible. Rough estimates suggest that these costs could be recovered in a single year by as little as a 10% reduction in the rate of abuse and neglect.