Meta-analysis finds parenting interventions work best in helping children with disruptive behaviour problems

A meta-analysis published in the journal Paediatrics has identified the critical role that parents play in interventions aimed at helping children with disruptive behaviour problems and suggests policy makers should take note.

US researchers led by Dr Richard Epstein found that parenting interventions work better either on their own or in combination with other interventions when compared to child-only interventions for children with disruptive problems, the review of previously published studies found.

Results from the meta-analysis also show that all intervention categories were more effective than the treatment as usual/control category.

The authors of Psychosocial Interventions for Child Disruptive Behaviors: A Meta-analysis write:

“Our meta-analytic model suggested that interventions categorized as multi-component interventions and interventions with only a parent component were approximately equivalent in their expected effectiveness (43% probability of being best treatment), whereas interventions with only a child component were estimated to be less effective (14% probability of being best).’’

While existing reviews report positive outcomes for cognitive-behavioral therapy,  behaviour management, and parenting interventions, either alone or in combination with family-based approaches, the authors suggest that evidence for interventions with a child-only component was limited because of the small number of studies and that the estimate for child-only interventions was imprecise. They continue:

“Given recent trends indicating reduced use of behavioural health services and increasing use of psychotropic medications, especially for children with disruptive behaviour disorders, we believe these findings have important policy and practice implications.’’

Triple P founder and director of the University of Queensland’s Parenting and Family Support Centre, Professor Matt Sanders, said the research added to the body of evidence highlighting the importance of parent-focused interventions in treating child disruptive behaviours, including Triple P.

A meta-analysis of more than 100 studies of Triple P has demonstrated positive impacts for child and parent outcomes.

“The current study suggests to parents, practitioners and policy makers that parent interventions may be the most effective means of helping children with disruptive behaviour problems. It points out that these kinds of problems are among the most common child and adolescent psychiatric disorders and are associated with significant impairment,’’ Professor Sanders said.

As the study authors suggest:

“Policymakers may consider incentivising psychosocial interventions that include a parent component to increase the delivery of interventions that have the greatest potential to improve care for these vulnerable children and families.’’

To reach parents in a culturally sensitive way we first need to listen to the local community

More than 90 per cent of the world’s children and families live in low- and middle-income countries.

So how do we reach them in a culturally sensitive way?

In our project in Panama, we tested the efficacy of Triple P Discussion Groups with 108 parents from six high-risk, low-resource neighborhoods.

Even though the intervention was delivered in its original form, “intuitive” cultural adaptations took place during delivery.

For example, we started sessions with an ice breaker activity, we worked with local facilitators and used local jargon when giving examples.

I come from a family of social workers in Panama and so my passion has always been to support families living in poverty.  But to help them in a respectful way, I firstly needed to understand what is it like to live and raise a child in a high-risk neighbourhood.

I also wanted others around the world to understand the experiences of families living in poverty.  I was pretty sure that images would speak louder than any words.

The idea then was to film a short documentary in collaboration with two mothers from San Joaquin.

San Joaquin is a high-risk community in Panama City recognized as the epicenter of violence and home to the deadliest gangs in the country.  This 10-minute documentary follows the life of Cecilia and Dora, two mothers who also took part in the Triple P intervention.  It’s interesting to see how both mothers show great resilience in their discourse even though they are facing daily adversity.

Filming this documentary made me understand the importance of using collaborative approaches to increase engagement of community members with new interventions.  This documentary allowed me to give voice to mothers who would otherwise not have any platform to speak up.  They felt as if they were active participants disseminating results from the project and became the main advocates for it.  Participatory research such as this increases ownership, sustainability and ensures interventions fit local needs and culture.

Using this work in Panama as a case example, and in collaboration with other researchers at the Parenting and Family Support Centre at the University of Queensland, I’m currently involved in developing and testing models to approach new communities in a collaborative, participatory way.

We feel it’s important that programs are sustainable once they have been introduced into a new community. In order to do this, we’re exploring models or ways to listen to the community and learn about its local history.

By doing this, we hope to understand how local people who want to bring about change in those communities would like to deliver the program, rather than imposing change from the top down.

We are developing guidelines to conduct cultural engagement in a systematic manner.  These guidelines will provide “conceptual lenses” to practitioners and researchers delivering and implementing Triple P in any context or culture worldwide, such as with families in low- and middle-income countries, refugee parents and Indigenous communities in Australia.

And in turn, we hope to give the voice of change back to the community.

Note: All participants provided written informed consent for the dissemination of this footage for academic purposes.

For more information on the RCT:  Mejia, A., Calam, R., & Sanders, M.R. (2015).  A pilot randomized controlled trial of a brief parenting intervention in low resource settings in Panama. Prevention Science. DOI: 10.1007/s11121-015-0551-1

 

Inaugural inductees Kelston boys high school

Proud rugby school famous for turning out All Blacks takes Triple P founder back to where it all began

A New Zealand boys high school famous for its connection to the mighty All Blacks has recognised The University of Queensland’s Professor Matt Sanders among its first distinguished alumni.

Professor Sanders is the founder of the Triple P – Positive Parenting Program, a Professor of Clinical Psychology and director of UQ’s Parenting and Family Support Centre. He has published more than 300 research papers.

However, as a very young student at Kelston Boys High School, in West Auckland, Professor Sanders says he was not one of the top academic achievers.

“The key for me was that my very early academic career wasn’t seen by the school as a limitation. I had one teacher in particular who got me aside and basically told me, ‘come on, you can do it’,’’ Professor Sanders said.

“For me it reinforces the idea that people should not make too many judgments too soon about young people and what they are capable of if they have good family and school support.’’

Professor Sanders (pictured left in picture above), who attended Kelston from 1966-70, was recognised at Keltson’s inaugural alumni for his achievements in academia alongside the chief executive of the Pascoe Group, David Norman (1962-1965, second from left), for his services to business; current New Zealand Sevens rugby union captain, DJ Forbes (1997-2000, second from right), for services to sport; and former New Zealand rugby league captain, Duane Mann (1979-1983, right), for services to the community and sport.

Kelston principal Brian Evans said the school was honoured to have someone of the calibre of Prof Sanders as one of its first distinguished alumni.

“Professor Sanders’ work and achievements speak for themselves and he is a very proud Kelstonian and an inspiration for our current students on what can be achieved with such dedication,’’ Mr Evans said.

“It was a wonderful evening for our old boys and a great celebration of what great things our ex-students go on to achieve.’’

Kelston Boys High School in West Auckland is highly regarded for the quality of its rugby program, with former All Blacks coach Graham Henry a former principal of the school, and for its support of Maori and Pacific Island families.

Professor Sanders graduated from Kelston to enrol at University of Auckland where he completed three degrees, a Bachelor of Arts, a Master of Arts and a Dip Ed in Psychology before starting his PhD thesis which was the genesis of Triple P.

He then transferred to The University of Queensland where his completed his doctorate.