TRIPLE P-POSITIVE PARENTING PROGRAM FOR CHILDREN WITH EXTERNALIZING AND INTERNALIZING PROBLEMS Jenna Jones, Melissa Wuerch, Fedaa Beiti, Cory Saunders, & Sylvia Voelker University of Windsor, Windsor, Ontario, Canada ABSTRACT Triple P (Positive Parenting Program) is an evidence-based parent management training program based on social learning theory principles (Sanders, 2012). Parents are taught parenting skills in eight weekly sessions through instruction, role playing, and individualized consultation with a trained facilitator. Although there is evidence that supports the effectiveness of this program for children presenting with externalizing problems, it is unclear how effective it is for children presenting with comorbid internalizing and externalizing problems. This study evaluated the effectiveness of level 4 Group Triple P in a sample of children (N = 44) seeking treatment at a child mental health clinic who presented with clinical levels of externalizing problems only (n = 19), or with clinical levels of both internalizing and externalizing problems (n = 25). Parents completed a set of questionnaires that are standard to the Triple P program on the first and last session. The results indicated that the program was generally effective in improving the child’s mental health and that there was no differential treatment effect overall. These findings imply that the program is similarly effective for ameliorating mental health problems in children presenting with externalizing problems alone and those with comorbid difficulties. INTRODUCTION • Triple P (Positive Parenting Program) is an evidence-based intervention for improving parenting skills and child mental health concerns • It is a multimodal program, with 5 levels of intensity • In level 4 Group Triple P, parents are provided with skills training in a group setting • Externalizing problems refer to negative behaviour directed outside the individual, such as hyperactivity, aggression, and noncompliance • Internalizing problems refer to negative emotions within the individual, such as depression, anxiety, and social withdrawal (Gilliom & Shaw, 2004). • It is important to understand the effectiveness of Triple P for these groups since it is very common for children to have comorbid difficulties, and these children are often excluded from efficacy trials (Gilliom & Shaw, 2004) RESULTS 2x2 mixed model MANOVA, outcome was 5 SDQ subscales Time main effect: • Improvement overall (p < .001) • Improvement on all subscales (ps < .009) except Peer Problems (p = .078) Group main effect: • Comorbid group had higher scores overall (p = .014) • Comorbid group had higher scores on Emotional Symptoms (p < .001), but none of the other subscales (ps > .086) Time x Group interaction: • No interaction overall (p = .105) • No interaction on most subscales (ps > .097) • Externalizing Only group had steeper declines in Hyperactivity (p = .037) CONCLUSION • General support for the effectiveness of level 4 Group and Group-Teen Triple P in a Canadian clinic-based sample • Triple P is similarly effective for children presenting with externalizing problems alone and those with comorbid internalizing and externalizing problems • Steeper declines in hyperactivity for children with externalizing problems only were found, which could be more due to environmental influences for these children • Triple P may be useful in addressing internalizing problems, which should be tested more directly in future research • Limitations include missing data, reliance on self-report and small sample size REFERENCES • Cunningham, C. E., Boyle, M. H., Hong, S., Pettingill, P., & Bohaychuk, D. (2008). The Brief Child and Family Phone Interview (BCFPI): 1. Rationale, development, and description of a computerized children’s mental health intake and outcome assessment tool. Journal of Child Psychology and Psychiatry, 50(4), 416-423. doi:10.1111/j.1469-7610.2008.01970.x • Gilliom, M., & Shaw, D. S. (2004). Codevelopment of internalizing and externalizing problems in early childhood. Development and Psychopathology, 16, 313-333. doi: 10.10170S0954579404044530 • Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581-586. • Sanders, M. R. (2012). Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annual Review of Clinical Psychology, 8, 345-379. doi: 10.1146/annurev-clinpsy-032511-143104 Presented at the 2014 Annual Convention of the American Psychological Association in Washington, D.C. www.triplep.net METHOD PARTICIPANTS • 178 parents who were clients of Windsor Regional Children’s Centre took part in Level 4 Group or Group-Teen Triple P between 2006- 2013 • Of these participants, groups were formed for those with clinical levels of Externalizing Symptoms Only (n = 19) or clinical levels of Comorbid Externalizing and Internalizing Symptoms (n = 25), overall N = 44 • 74% male children, aged 4-16 years, 71% mothers PROCEDURE • Parents participated in Level 4 Group or Group-Teen Triple P • 8 weekly sessions (5 in person, 3 telephone), held in groups of up to 12 families • Parents filled out a set of questionnaires on the first and last sessions MEASURES • Demographic Information • Brief Child and Family Phone Interview (BCFPI; Cunningham et al., 2009) • Standardized intake and screening measure • Used to derive groups based on Internalizing and Externalizing scales • Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) • 25 item behavioural screening measure for children • Subscales include: • Emotional Symptoms • Conduct Problems • Hyperactivity • Peer Problems • Prosocial Behaviour
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TRIPLE P-POSITIVE PARENTING PROGRAM FOR CHILDREN WITH EXTERNALIZING AND INTERNALIZING PROBLEMS
Jenna Jones, Melissa Wuerch, Fedaa Beiti, Cory Saunders, & Sylvia Voelker
University of Windsor, Windsor, Ontario, Canada
ABSTRACT Triple P (Positive Parenting Program) is an evidence-based parent management training program based on social learning theory principles (Sanders, 2012). Parents are taught parenting skills in eight weekly sessions through instruction, role playing, and individualized consultation with a trained facilitator. Although there is evidence that supports the effectiveness of this program for children presenting with externalizing problems, it is unclear how effective it is for children presenting with comorbid internalizing and externalizing problems. This study evaluated the effectiveness of level 4 Group Triple P in a sample of children (N = 44) seeking treatment at a child mental health clinic who presented with clinical levels of externalizing problems only (n = 19), or with clinical levels of both internalizing and externalizing problems (n = 25). Parents completed a set of questionnaires that are standard to the Triple P program on the first and last session. The results indicated that the program was generally effective in improving the child’s mental health and that there was no differential treatment effect overall. These findings imply that the program is similarly effective for ameliorating mental health problems in children presenting with externalizing problems alone and those with comorbid difficulties.
INTRODUCTION
• Triple P (Positive Parenting Program) is an evidence-based intervention for improving parenting skills and child mental health concerns
• It is a multimodal program, with 5 levels of intensity • In level 4 Group Triple P, parents are provided with skills training in a
group setting • Externalizing problems refer to negative behaviour directed outside
the individual, such as hyperactivity, aggression, and noncompliance • Internalizing problems refer to negative emotions within the
individual, such as depression, anxiety, and social withdrawal (Gilliom & Shaw, 2004).
• It is important to understand the effectiveness of Triple P for these groups since it is very common for children to have comorbid difficulties, and these children are often excluded from efficacy trials (Gilliom & Shaw, 2004)
RESULTS
2x2 mixed model MANOVA, outcome was 5 SDQ subscales Time main effect: • Improvement overall (p < .001) • Improvement on all subscales (ps < .009) except Peer Problems (p = .078)
Group main effect: • Comorbid group had higher scores overall (p = .014) • Comorbid group had higher scores on Emotional Symptoms (p < .001), but none of the other subscales (ps > .086)
Time x Group interaction: • No interaction overall (p = .105) • No interaction on most subscales (ps > .097) • Externalizing Only group had steeper declines in Hyperactivity (p = .037)
CONCLUSION
• General support for the effectiveness of level 4 Group and Group-Teen Triple P in a Canadian clinic-based sample
• Triple P is similarly effective for children presenting with externalizing problems alone and those with comorbid internalizing and externalizing problems
• Steeper declines in hyperactivity for children with externalizing problems only were found, which could be more due to environmental influences for these children
• Triple P may be useful in addressing internalizing problems, which should be tested more directly in future research
• Limitations include missing data, reliance on self-report and small sample size
REFERENCES
• Cunningham, C. E., Boyle, M. H., Hong, S., Pettingill, P., & Bohaychuk, D. (2008). The Brief Child and Family Phone Interview (BCFPI): 1. Rationale, development, and description of a computerized children’s mental health intake and outcome assessment tool. Journal of Child Psychology and Psychiatry, 50(4), 416-423. doi:10.1111/j.1469-7610.2008.01970.x
• Gilliom, M., & Shaw, D. S. (2004). Codevelopment of internalizing and externalizing problems in early childhood. Development and Psychopathology, 16, 313-333. doi: 10.10170S0954579404044530
• Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581-586. • Sanders, M. R. (2012). Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annual Review of Clinical Psychology, 8, 345-379. doi:
10.1146/annurev-clinpsy-032511-143104
Presented at the 2014 Annual Convention of the American Psychological Association in Washington, D.C. www.triplep.net
METHOD
PARTICIPANTS • 178 parents who were clients of Windsor Regional Children’s Centre
took part in Level 4 Group or Group-Teen Triple P between 2006-2013
• Of these participants, groups were formed for those with clinical levels of Externalizing Symptoms Only (n = 19) or clinical levels of Comorbid Externalizing and Internalizing Symptoms (n = 25), overall N = 44
• 74% male children, aged 4-16 years, 71% mothers PROCEDURE • Parents participated in Level 4 Group or Group-Teen Triple P • 8 weekly sessions (5 in person, 3 telephone), held in groups of up to
12 families • Parents filled out a set of questionnaires on the first and last sessions
MEASURES • Demographic Information • Brief Child and Family Phone Interview (BCFPI; Cunningham et al.,
2009) • Standardized intake and screening measure • Used to derive groups based on Internalizing and Externalizing
scales • Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) • 25 item behavioural screening measure for children • Subscales include: • Emotional Symptoms • Conduct Problems • Hyperactivity • Peer Problems • Prosocial Behaviour
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