25/02/2013 OVERVIEW Increasing accessibility to evidence- - PDF document

25/02/2013 OVERVIEW  Increasing accessibility to evidence- Examining the effectiveness of based parenting support Triple P Online  Comparing online and workbook delivery of Triple P  The role of child, parent, and family Cassandra K. Dittman, Matthew R. Sanders factors in predicting success in Triple Susan P. Farruggia, Louise J. Keown, and P Online Melanie L. Palmer Project supported by a University of Auckland Faculty Research Development Fund Name of presentation Month 2009 Name of presentation Month 2009 WHY DON’T PARENTS COME THE ONGOING CHALLENGE ALONG? Motivational and attitudinal factors  Stigma associated with attending a parenting program  Beliefs that participation involves admitting Parenting But, parents ‘failure’ or ‘weakness’ don’t always programs Practical and lifestyle barriers work. access them!  Time and scheduling demands  Geographical constraints  Mismatch in delivery preferences Name of presentation Month 2009 Name of presentation Month 2009 THE BENEFITS OF SELF- NKOTB: ONLINE PARENTING DIRECTED PROGRAMS PROGRAMS Preserve the Reduce stigma Highly Interactive and privacy of of accessing favoured feature- parents support modality packed Address And they Useful for low And they work! work too! logistical literacy parents (O’Brien & Daley, 2011) (Enebrink et al., 2011; barriers Sanders et al., 2012) Name of presentation Month 2009 Name of presentation Month 2009 1

25/02/2013 THE NONINFERIORITY THE CURRENT PROJECT RESEARCH DESIGN  A head-to-head comparison of the new Triple  Null hypothesis = TPOL is inferior to the P Online with the existing Every Parent’s Self - workbook by at least a prespecified and Help Workbook empirically-derived noninferiority margin  Alternative hypothesis = TPOL is inferior to  Noninferiority RCT comparing effects on child the workbook by less than the noninferiority behaviour and parenting margin  Also examined effects of each intervention on  Noninferiority margin a number of child, parenting, and family • Derived from past RCT on the workbook outcomes at post-intervention and 6-month • Cohen’s d = 0.20 follow up Name of presentation Month 2009 Name of presentation Month 2009 THE TRIPLE P SYSTEM OF PARTICIPANTS INTERVENTION Breadth of reach  N = 192 (TPOL = 97, Workbook = 95)  Recruited from around New Zealand Level 1  Target child Media & communication strategy Intensity of intervention • 3 to 8 years (mean = 5.64 years) • 67% male, 33% female Brief parenting advice Level 2 • 87% with clinical level conduct problems  Families Level 3 Narrow focus parenting support • Mothers’ mean age = 37.19 years; fathers’ mean age = 39.63 years • Level 4 77% two-parent biological; 14% sole-parent; Broad focus parenting support 7% step-family • 83% completed high school, 47% university Level 5 Intensive family intervention educated Name of presentation Month 2009 THE INTERVENTION CONDITIONS  Every Parent’s Self -Directed Workbook • 10-module program involving readings, exercises, and structured practice sessions  Triple P Online • Designed to be highly interactive and engaging • User-friendly interface and navigation • Audiovisual presentation of information and strategies • Goal-setting and exercises for checking mastery • Downloadable tipsheets, monitoring forms, podcasts • Customisable and printable parent workbook • Review and reminder strategies Name of presentation Month 2009 Name of presentation Month 2009 2

25/02/2013 PRE-POST IMPROVEMENT: PRE-POST IMPROVEMENT: ECBI-INTENSITY ECBI-PROBLEM 45 12 40 10 35 30 8 25 6 20 15 4 d = -.09 d = -.16 d = -.13 d = -.14 10 2 5 0 0 Mothers Fathers Mothers Fathers Workbook Triple P Online Workbook Triple P Online Name of presentation Month 2009 Name of presentation Month 2009 TPOL: SHORT-TERM EFFECTS PRE-POST IMPROVEMENT: FOR MOTHERS I PARENTING SCALE (OVR) Pre Post Effect size Descriptor M (SD) M (SD) d 1.2 ECBI Intensity 155.60 (20.71) 114.17 (23.77) Large 1.54 1 Large ECBI Problem 22.40 (5.80) 10.92 (7.50) 1.44 0.8 Over-reactivity 3.61 (0.77) 2.57 (0.77) 1.29 Large 0.6 Laxness 2.79 (0.81) 2.16 (0.80) 1.00 Large 0.4 d = -.03 d = .05 0.2 Verbosity 3.73 (0.79) 2.73 (0.91) 1.06 Large 0 Setting Self 79.10 (10.25) 90.46 (7.07) -1.27 Large Mothers Fathers Efficacy Workbook Triple P Online Behaviour Self 67.75 (14.07) 86.20 (11.85) -1.38 Large Efficacy Name of presentation Month 2009 TPOL: SHORT-TERM EFFECTS PRELIMINARY CONCLUSIONS FOR MOTHERS II Pre Post Effect size Descriptor M (SD) M (SD) d 1. Triple P Online is effective when compared Parental Anger 124.10 (29.70) 111.62 (35.23) Small 0.46 to a waitlist control (Sanders et al., 2012) Child Abuse 5.13 (4.03) 3.56 (3.34) 0.49 Small 2. Triple P Online is not inferior (equivalent) in Risk its effectiveness to the Every Family Depression 5.23 (6.03) 3.52 (5.36) 0.27 Small workbook Anxiety 2.86 (4.23) 1.65 (2.78) 0.38 Small • Comparable effectiveness of both programs = choice for parents and Stress 11.91 (6.87) 6.90 (5.67) 0.66 Medium services Interparental 5.24 (3.54) 3.34 (2.50) 0.66 Medium • Highlights the value of the noninferiority Conflict approach Parent Child 41.08 (7.00) 52.51 (6.44) -1.49 Large Relationship Name of presentation Month 2009 3

25/02/2013 WHAT PREDICTS TPOL PRELIMINARY CONCLUSIONS CHILD BEHAVIOUR OUTCOMES? Significant No predictive BUT… predictors association • Session • Family SES Is Triple P Online effective for families: completion ( β = - factors • from diverse SES backgrounds? .33) • Child factors • T1 parent-child • T1 child behaviour • with high levels of child behaviour relationship quality severity problems? ( β = -.24) • T1 level of parenting difficulty • Father involvement Name of presentation Month 2009 Name of presentation Month 2009 WHAT PREDICTS TPOL IMPLICATIONS & PARENTING OUTCOMES? CONSIDERATIONS Significant No predictive  Well-established family and child risk factors predictors association may not have a large influence on success in • Session • Family SES online parenting programs completion ( β = factors  Points to the importance of identifying and -.41) • Child factors testing strategies to maximise retention • T1 ineffective • T1 child  Possible strategies: parenting ( β = behaviour • Adjunctive professional support (e.g., by .47) severity telephone, Skype, or online messaging), • Father • Peer support via social networking involvement • Moving beyond ‘grandfather machines’ Name of presentation Month 2009 Name of presentation Month 2009 4