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With the evidence still uncertain, where to next for interventions for new parents?

The first three years of life have long been recognised as fundamental to a child’s future development, and the role of parents in those early years is widely acknowledged as being critical.

For the new parent, there is an abundance of information on parenting babies both in the popular media and from health and social service agencies.

Yet how much of this is evidence-based and how much do we really know about what interventions work for parents of under threes?  Although there are still many gaps in our knowledge about parenting interventions for older children, these are minor compared to those for parents of babies.

Triple P is a widely known evidenced-based parenting intervention, and while there is support for its effectiveness in the toddler and pre-schooler years (for example, Morawska & Sanders, 2006) and into the primary school years, there is still limited evidence for interventions that target parents of babies.

This is not unique to Triple P. Most parenting programs target older children, and the majority of evidence-based, widely disseminated programs such as Triple P and Incredible Years is for older children.

Addressing the gap

To address this significant gap in supporting parents in the early years of parenting we developed Baby Triple P. Baby Triple P was designed as a comprehensive, preventative, group-based approach to support parents at the transition to parenthood, and targets known risks factors common across the transition (i.e., early parenting confidence and behaviour, parental coping, and supporting the couple relationship).

Our efforts to evaluate the efficacy of Baby Triple P are ongoing but to date findings have been mixed and largely not supportive of the efficacy of the program.

Interestingly, a recently published pre-post trial of Incredible Years Parents and Babies found limited evidence of effectiveness (Jones, Erjavec, Viktor, & Hutchings, 2016). Incredible Years, like Triple P, is based on social learning principles and has a strong evidence base, so it is intriguing that this version of the program has also shown few positive outcomes.

Four randomised controlled trials to date for Baby Triple P (Mihelic, Morawska, & Filus, 2016b; Seah & Morawska, 2016; Spry, 2013; Tsivos, Calam, Sanders, & Wittkowski, 2015) have shown two things: parents really like the intervention and yet report no or very limited change in any of the outcomes assessed. Each of these trials had significant limitations. For example, the sample in Spry (2013) was older, more educated, better off financially and better adjusted than the general population, thus causing ceiling effects on all outcome measures at baseline.

Several large-scale studies are currently ongoing in Australia and Scotland with more high-risk and vulnerable families. These studies will provide more definitive evidence pertaining to longer term effects of Baby Triple P.

Parents clearly like Baby Triple P

What we do know currently, however, is that parents clearly like Baby Triple P and find it highly acceptable, including families with premature babies (Ferrari, Whittingham, Boyd, Sanders, & Colditz, 2011), mothers in a psychiatric unit (Butler, Hare, Walker, Wieck, & Wittkowski, 2014), and mothers suffering from postnatal depression (Tsivos, Calam, Sanders, & Wittkowski, 2015).

Many parents and practitioners continue to ask for the program, often noting that there simply are no available parenting programs for them. One randomised trial even had to be discontinued because parents so desperately wanted the information in the program (Popp & Schneider, 2015).

Parents of babies clearly want evidence-based parenting programs. Practitioners tell us that few options are available and are very keen to know when Baby Triple P will become available.

verticle babyHowever, the research evidence for all parenting interventions targeting new parents suggests that all existing approaches to date have had limited effects.

Systematic reviews of specifically targeted interventions have found limited evidence of positive effects for outcomes such as infant sleep for babies under 6 months of age (Douglas & Hill, 2013).

Our own recent meta-analysis of interventions targeting early infant and parenting behaviours (Mihelic, Morawska, & Filus, 2016a), found only five studies that examined parenting competence and confidence. This means that while parenting skill and their confidence in their own ability as parents are recognised as important (Mihelic, Filus, & Morawska, 2016), few interventions actually aim to help parents enhance these.

A meta-analysis of more than 140 early parenting interventions, starting during pregnancy or the first six-months postpartum, found very small to small intervention effects and only for some outcomes (Pinquart & Teubert, 2010). The authors found that shorter, more targeted interventions, and older studies tended to show stronger effects.

The fact that older studies tend to show larger effect sizes might suggest that parents these days have access to much more information at their fingertips, making it more difficult for modern-day studies to show effects. However, we are still a long way from knowing whether or not this is the case. What we do know that despite this abundance of information, parents still clearly want an intervention such as Baby Triple P.

So where to now for Baby Triple P, a program that has been much anticipated by many people familiar with the Triple P system of programs?

We think the theoretical approach we have taken is sound, and the specific strategies incorporated into Baby Triple P are appropriate, but we have begun rethinking how we design the intervention and how we target delivery to parents with specific needs.

Perhaps we have tried to target too many varied factors within the existing intervention, making the job of detecting the effects on a specific outcome, such as baby crying, too difficult? Our next efforts will involve more targeted interventions, focusing on parents with identified needs.

At the same time, we will continue to work with parents and examine the theoretical literature to determine how best to tailor the program.

Parenting in infancy matters and we need to make sure we design and test effective programs for parents. And although it can be tempting to disseminate a program that parents and practitioners are asking for, Baby Triple P has not yet been disseminated.

We will continue to develop and test interventions for parents of babies in an effort to support those fundamental early days and months of development.

 

Other references:

 

Mihelic, M., Morawska, A., & Filus, A. (2016a). Effects of early parenting interventions on parents and infants: A meta-analytic review. Under review.

Mihelic, M., Morawska, A., & Filus, A. (2016b, 22-25 June). How effective is Baby Triple P for parenting confidence and the mother-infant relationship? . Paper presented at the 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, Australia.

Seah, C. K. F., & Morawska, A. (2016). Does Baby Triple P increase responsive parenting, efficacy and reduce parental stress? A randomized controlled trial of an early parenting intervention. Under review.

 

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Disclosure statement

Alina Morawska receives funding from the Australian Research Council, and she has received funding from Family Planning Queensland. The Triple P – Positive Parenting Program is owned by The University of Queensland. The University, through its main technology transfer company, UniQuest Pty Ltd, has licensed Triple P International Pty Ltd to publish and disseminate the program worldwide. Royalties stemming from published Triple P resources are distributed in accordance with the University’s intellectual property policy and flow to the Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Alina Morawska is an author of various Triple P resources.