Effectiveness of Primary Care Triple P on child psychosocial problems in preventive child healthcare: a randomized controlled trial

Willem Spijkers, Daniëlle Emc Jansen, Sijmen A Reijneveld, Willem Spijkers, Daniëlle Emc Jansen, Sijmen A Reijneveld

Abstract

Background: Psychosocial problems in children have adverse effects on the children, their families, and society, thus early intervention is important. Community pediatric services offer an ideal setting to detect problem behaviour in children and provide support to parents. The objective of this study was to assess the effectiveness of a Primary Care Triple P (PCTP) program compared with care as usual (UC) for parents of children with mild psychosocial problems after an initial, evidence-based screening in routine community pediatric care.

Methods: We conducted a multicenter, randomized, controlled trial in community pediatric services in the Netherlands, enrolling parents of children with mild psychosocial problems. The population was identified by screening using the Strengths and Difficulties Questionnaire (SDQ) with a cut-off point of 11 or higher (that is, a subclinical score). We compared PCTP with UC, and measured the effects immediately after treatment and after 6 and 12 months. PCTP comprised four individual counseling sessions with the parent of 20 to 30 minutes each. The primary outcome measures were the child psychosocial problems as measured by the SDQ and the Eyberg Child Behaviour Inventory (ECBI).

Results: In total, 81 families were recruited and randomized, and 67 provided post-intervention data. Both treatment groups improved after treatment, with the PCTP group improving only slightly more than the UC group on most measures. The maximum difference on the SDQ was 1.94 (95% CI = -0.30 to 4.19, P = 0.09) and 5.81 (95% CI = -3.37 to 14.99, P = 0.21) on the ECBI (n = 67). None of the differences between PCTP and UC was significant. In the subsidiary analyses, only one of the twenty outcomes (that is, SDQ conduct problems) was significant.

Conclusions: PCTP did produce a reduction in psychosocial problems in children but had no statistically significant advantage over UC. In general, a few outcomes improved in both groups. Based on this admittedly underpowered study, we cannot conclude that PCTP is more effective than UC in preventive child healthcare.

Figures

Figure 1
Figure 1
Flowchart of participants through the study, following CONSORT guidelines.
Figure 2
Figure 2
Estimated means and 95% confidence intervals for the Strengths and Difficulties Questionnaire Total Difficulties Score (SDQ-TDS; primary outcome) by treatment group. The analysis was corrected for baseline values. Intervention group is represented by the red line and diamonds for the point estimate and the 95% confidence interval borders. Usual care group is represented by the blue line and crosses for the point estimate and the 95% confidence interval borders.

References

    1. Theunissen MHC, Vogels AGC, Reijneveld SA. Work experience and style explain variation among pediatricians in the detection of children with psychosocial problems. Acad Pediatr. 2012;12:495–501. doi: 10.1016/j.acap.2012.07.004.
    1. Crone MR, Bekkema N, Wiefferink CH, Reijneveld SA. Professional identification of psychosocial problems among children from ethnic minority groups: room for improvement. J Pediatr. 2010;156:277–284. doi: 10.1016/j.jpeds.2009.08.008.
    1. Rushton J, Bruckman D, Kelleher K. Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med. 2002;156:592–598. doi: 10.1001/archpedi.156.6.592.
    1. Smith JP, Smith GC. Long-term economic costs of psychological problems during childhood. Soc Sci Med. 2010;71:110–115. doi: 10.1016/j.socscimed.2010.02.046.
    1. Anthony LG, Anthony BJ, Glanville DN, Naiman DQ, Waanders C, Shaffer S. The relationships between parenting stress, parenting behaviour and preschoolers’ social competence and behaviour problems in the classroom. Infant Child Dev. 2005;14:133–154. doi: 10.1002/icd.385.
    1. Steinberg L, Lamborn SD, Dornbusch SM, Darling N. Impact of parenting practices on adolescent achievement: authoritative parenting, school involvement, and encouragement to succeed. Child Dev. 1992;63:1266–1281. doi: 10.2307/1131532.
    1. Fletcher AC, Walls JK, Cook EC, Madison KJ, Bridges TH. Parenting style as a moderator of associations between maternal disciplinary strategies and child well-being. J Fam Issues. 2008;29:1724–1744. doi: 10.1177/0192513X08322933.
    1. Morawska A, Winter L, Sanders MR. Parenting knowledge and its role in the prediction of dysfunctional parenting and disruptive child behaviour. Child Care Health Dev. 2009;35:217–226. doi: 10.1111/j.1365-2214.2008.00929.x.
    1. Caspi A, Moffitt TE, Newman DL, Silva PA. Behavioural observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort. Arch Gen Psychiatry. 1996;53:1033–1039. doi: 10.1001/archpsyc.1996.01830110071009.
    1. Nelson G, Westhues A, Macleod J. A meta-analysis of longitudinal research on preschool prevention programs for children. Prevention and Treatment. 2003;6(1) No Pagination Specified Article 31a. doi: 10.1037/1522-3736.6.1.631a.
    1. Sanders MR. Triple P-Positive Parenting program: towards an empirically validated multilevel parenting and family support strategy for the prevention of behaviour and emotional problems in children. Clin Child Fam Psychol Rev. 1999;2:71–90. doi: 10.1023/A:1021843613840.
    1. Sanders MR. Triple P-Positive Parenting Program as a public health approach to strengthening parenting. J Fam Psychol. 2008;22:506–517.
    1. De Graaf I, Speetjens P, Smit F, De Wolff M, Tavecchio L. Effectiveness of the Triple P Positive Parenting Program on behavioural problems in children: a meta-analysis. Behav Modif. 2008;32:714–735. doi: 10.1177/0145445508317134.
    1. De Graaf I, Speetjens P, Smit F, De Wolff M, Tavecchio L. Effectiveness of the Triple P Positive Parenting program on parenting: a meta-analysis. Fam Relat. 2008;57:553–566. doi: 10.1111/j.1741-3729.2008.00522.x.
    1. Boyle CL, Sanders MR, Lutzker JR, Prinz RJ, Shapiro C, Whitaker DJ. An analysis of training, generalization, and maintenance effects of Primary Care Triple P for parents of preschool-aged children with disruptive behaviour. Child Psychiatry Hum Dev. 2010;41:114–131. doi: 10.1007/s10578-009-0156-7.
    1. de Graaf I, Onrust S, Haverman M, Janssens J. Helping families improve: an evaluation of two primary care approaches to parenting support in the Netherlands. Infant Child Dev. 2009;18:481–501. doi: 10.1002/icd.634.
    1. Turner KMT, Sanders MR. Help when it’s needed first: a controlled evaluation of brief, preventive behavioural family intervention in a primary care setting. Behav Ther. 2006;37:131–142. doi: 10.1016/j.beth.2005.05.004.
    1. McConnell D, Breitkreuz R, Savage A. Independent evaluation of the Triple P Positive Parenting Program in family support service settings. Child & Family Social Work. 2012;17:43–54. doi: 10.1111/j.1365-2206.2011.00771.x.
    1. Wilson P, Rush R, Hussey S, Puckering C, Sim F, Allely C, Doku P, McConnachie A, Gillberg C. How evidence-based is an ‘evidence-based parenting program’? a PRISMA systematic review and meta-analysis of Triple P. BMC Med. 2012;10:130. doi: 10.1186/1741-7015-10-130.
    1. Coyne J, Kwakkenbos L. Triple P-Positive Parenting programs: the folly of basing social policy on underpowered flawed studies. BMC Med. 2013;11:11. doi: 10.1186/1741-7015-11-11.
    1. Eisner M. No effects in independent prevention trials: can we reject the cynical view? J Exp Criminol. 2009;1:163–183.
    1. Spijkers W, Jansen DE, de Meer G, Reijneveld SA. Effectiveness of a parenting programme in a public health setting: a randomised controlled trial of the positive parenting programme (Triple P) level 3 versus care as usual provided by the preventive child healthcare (PCH) BMC Public Health. 2010;10:131. doi: 10.1186/1471-2458-10-131.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration. Ann Intern Med. 2008;148:295–309. doi: 10.7326/0003-4819-148-4-200802190-00008.
    1. Sanders MR, Markie-Dadds C, Turner KMT. Theoretical, scientific and clinical foundations of the Triple P-Positive Parenting Program: a population approach to the promotion of parenting competence. Parenting Research and Practice Monograph. 2010;1:1–21.
    1. Sanders MR, Turner KMT, Markie-Dadds C. The development and dissemination of the triple P - Positive Parenting Program: a multilevel, evidence-based system of parenting and family support. Prev Sci. 2002;3:173–189. doi: 10.1023/A:1019942516231.
    1. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40:1337–1345. doi: 10.1097/00004583-200111000-00015.
    1. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x.
    1. Robinson EA, Eyberg SM, Ross AW. The standardization of an inventory of child conduct problem behaviours. J Clin Child Psychol. 1980;9(1):22–28. doi: 10.1080/15374418009532938.
    1. Arnold EH, O’Leary SG, Wolff LS, Acker MM. The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychol Assess. 1993;5:137–144.
    1. De Brock AJLL, Vermulst AA, Gerris JRM, Abidin RR. NOSI-Nijmeegse Ouderlijke Stress Index, Handleiding experimentele versie [NOSI-Nijmegen Parenting Stress Index, Manual experimental version] Lisse, Netherlands: Swets en Zeitlinger; 1992.
    1. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335–343. doi: 10.1016/0005-7967(94)00075-U.
    1. Hopewell S, Hirst A, Collins GS, Mallett S, Yu L, Altman DG. Reporting of participant flow diagrams in published reports of randomized trials. Trials. 2011;12.1(2011):253.
    1. Leung C, Sanders MR, Leung S, Mak R, Lau J. An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Fam Process. 2003;42:531–544. doi: 10.1111/j.1545-5300.2003.00531.x.
    1. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985;14:32–38. doi: 10.1093/ije/14.1.32.
    1. Turner KMT, Sanders MR, Markie-Dadds C. Practitioner’s Manual for Primary Care Triple P. Brisbane: Australian Academic Press; 1999.
    1. Reijneveld SA, de Meer G, Wiefferink CH, Crone MR. Parents’ concerns about children are highly prevalent but often not confirmed by child doctors and nurses. BMC Public Health. 2008;8:124. doi: 10.1186/1471-2458-8-124.
    1. Breitkreuz R, McConnell D, Savage A, Hamilton A. Integrating triple P into existing family support services: a case study on program implementation. Prev Sci. 2011;12:411–422. doi: 10.1007/s11121-011-0233-6.

Source: PubMed

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