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Meta-analysis finds Triple P effective in preventing antisocial behaviour and delinquency

More evidence has come to hand that parenting programs are an effective evidence-based strategy to prevent antisocial behaviour and delinquency.

A meta-analysis update on the effects of early family/parent training programs on antisocial behaviour and delinquency (Piquero et al., 2016) is an excellent and timely study which shows the huge value that evidence-based parenting programs represent.

If you think about the costs of violent and anti-social behaviour to society, for very little outlay, parenting programs reward investors many times over.

The study, published in the Journal of Experimental Criminology, updates and replicates Alex Piquero’s previous work published in 2009 which found that early family/parent training “is an effective intervention for reducing behaviour problems among young children’’.

The authors conclude:

“In short, early family/parent training programs are an important evidence-based strategy that deserves continued application and expansion as part of a more general strategy for building a safer society.’’

In comparing different interventions, the review authors place Triple P’s effect size of 0.56 midway between Parenting-Child Interaction Therapy (0.98) and The Incredible Years (0.37).

This is an extremely encouraging finding given that PCIT adopts a treatment approach, focusing on more difficult cases with “more room to move’’.

PCIT and, to a lesser extent, The Incredible Years are targeted, treatment interventions for families with children with well-established conduct problems.

In contrast, the Triple P multilevel system of parenting support is based on a population-based public health model which seeks to shift prevalence rates across the community.

Triple P’s approach blends early intervention, light touch programs designed with prevention in mind with more enhanced, targeted treatment options.

The Triple P studies reviewed by Piquero et al. included a mix of different delivery modalities such as over-the-phone, self-directed, and television programs – representing a mixture of brief, low-intensity prevention interventions (Sanders, Montgomery & Brechman-Toussaint) – and more intensive enhanced interventions (Sanders, Markie-Dadds, Tully & Bor).

Prevention interventions usually have lower base rates of problems and therefore less room to “improve” whereas treatment interventions such as PCIT typically have higher base rates and much greater capacity to show change over time as well as larger effect sizes.

An intensive intervention with multiple sessions (12 or more) may produce larger effect sizes than briefer interventions (eight or less sessions) but a brief intervention may have greater impact because it’s less expensive to deliver with more families able to be seen with the same allocation of practitioner time.

Generally meta-analyses of parent training have not looked at these issues of cost and population reach that an intervention can achieve.

Both treatment and prevention approaches are important and both need to be incorporated in any effort to treat and prevent anti-social behaviour and delinquency.

However, issues such as practitioner availability and the amount of time that parents can dedicate to participation are important factors that agencies need to weigh up when considering how to implement a prevention health approach.

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.’’

News about the research is spreading around the world but more families need to find out about Stepping Stones Triple P

At a time when educators, parents and policy advisors in Australia are grappling with how to deal with the emotional and behavioural needs of children with disabilities, Stepping Stones Triple P is demonstrating it can provide at least some of the answers.

The evidence is clear that rates of depression and anxiety are much higher for mothers of children with a developmental disability than those of typically developing children (Gray et al., 2011). We also know children with an intellectual disability are also more likely to be diagnosed with a psychiatric disorder, such as anxiety disorder, depression, and conduct disorder (Emerson, 2003; Gadow, Guttmann-Steinmetz, Rieffe, & DeVincent, 2012).

So when a paper is published confirming that evidence-based programs can help these families, I think we should all be shouting it from the rooftops, so that families and policy makers hear the message loud and clear.

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Brief, low-intensity interventions show promise in most comprehensive meta-analysis of the Triple P system to date

The recent publication of The Triple P – Positive Parenting Program: A Systematic Review and Meta-Analysis of a Multi-Level System of Parenting Support in Clinical Psychology Review is the most comprehensive meta-analytical assessment of Triple P to date.

This was the first meta-analysis of the Triple P system to examine the full range of outcomes that Triple P seeks to influence.

The meta-analysis investigated data compiled from reported outcomes of 16,009 families who have participated in a Triple P program over the past 33 years from a range of sources, including independent studies, unpublished studies and agencies delivering Triple P as part of regular service.

The most compelling finding for the value of the Triple P multi-level system is evidence that now shows that all delivery methods of Triple P – as well as the full suite of intervention levels – produce significant effects for children and their families.

This is important given that families themselves differ in terms of their preferences, the amount of time they have available to engage with a parenting program, their location and the presence of other sources of adversity in their lives.

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