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Title:
An analysis of training, generalization, and maintenance effects of Primary Care Triple P for preschool-aged children
Authors:
Boyle, C.L., Sanders, M.R., Luzker, J.R., Prinz, R.J., Shapiro, C., & Whitaker, D.J.
Journal:
Child Psychiatry and Human Development, 2010, 41, 114-131

Introduction:

Primary Care Triple P (PCTP) is a brief, level 3 intervention, designed for use in a variety of primary care settings including general medical practices, community child health clinics, and home visiting services. These settings are potentially advantageous for detecting parent-child difficulties and providing early intervention for parents whose children are at risk for child and adolescent mental health problems. Primary-care settings are potentially useful venues for delivering parenting programs because of the high prevalence of behavioral and emotional problems in children, inadequate resourcing of specialist mental health services, and resistance to attending mental health services due to perceived social stigma and lack of service availability.

Aim:

A brief primary care intervention for parents of preschool-aged children with disruptive behavior was assessed using a multiple probe design. Primary Care Triple P, a four session behavioral intervention was sequentially introduced within a multiple probe format to each of 9 families to a total of 10 children aged between 3 and 7 years (males = 4, females =  6).

Hypotheses:

The present study extends existing research on PCTP through the use of an intra-subject replication design, specifically a multiple probe across families design to explore the across setting generalization effects of the intervention. Parents of preschool-aged children with moderate severity conduct problems (the target group for the intervention) were sequentially introduced to PCTP in a multiple probe format. We predicted that families participating in PCTP would show: (1) decreased observed and parent-reported child behavior problems; (2) reduced observed and parent reported dysfunctional parenting practices; (3) increased parental self-efficacy; and (4) maintenance of intervention gains over time. Parental acceptability of PCTP and associated outcomes were also assessed.

Method:

Participants were ten children from nine families residing in two southern US cities. All were cohabitating, married, two-parent families. Recruitment occurred via solicitation by local pediatricians, print media, flyers, and word of mouth. Three families responded to print media; the remaining families were recruited through the CDC parent list serve in Atlanta GA. Responding parents were asked to complete the eyberg child behavior inventory (ECBI) and were interviewed about family details, child behavior, developmental history, child health status, child educational history, and family relationships and interactions. Inclusion criteria were that parents: (1) had to be the legal guardian and primary caregiver of a child whose ages were between 3- and 7-years; and (2) present with concerns about behavior problems that occurred primarily in the home. Exclusion criteria for parent and/or child were: (1) intellectual disabilities; (2) chronic medical problems; (3) psychological and/or psychiatric problems; (4) drug-addiction problems; (5) non-English speaking; and (6) children diagnosed with a conduct-related disorder. In total, nine families were selected to participate, including a total of ten children. All families were asked to sign consent forms for their participation. The nine families in the study were yoked for comparison in sets of either two or three families.

Results:

Independent observations of parent-child interaction in the home revealed that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent report data also confirmed there were significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the Parent Experience Survey, and high levels of consumer satisfaction. All short-term intervention effects were maintained at four-month follow-up.  

Conclusions and Implications:

The present study evaluated the efficacy of Primary Care Triple P as an intervention for parents of preschool-aged children with disruptive behavior using a multiple probe design. The present study extended upon existing research relating to PCTP by exploring the across setting generalization effects of the intervention. Observations of parent-child interaction in the home supported the efficacy of the intervention, with findings showing that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent data also revealed significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the Parent Experience Survey, and high levels of satisfaction. All short-term intervention effects were maintained at four-month follow-up. The current findings make an important contribution to the existing body of research exploring primary care settings and generalisation effects as they relate to the successful delivery of parenting interventions. Indeed, the generalization effects of parenting interventions such as PCTP are important, but remain understudied, and future studies may provide further insight into the mechanisms which underpin generalisation effects.

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Created: Friday, 20th August 2010 by jameskir
Modified: Monday, 7th March 2011 by jameskir
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