Elsevier

Aggression and Violent Behavior

Volume 11, Issue 2, March–April 2006, Pages 176-193
Aggression and Violent Behavior

Dissemination of evidence-based parenting and family support strategies: Learning from the Triple P—Positive Parenting Program system approach

https://doi.org/10.1016/j.avb.2005.07.005Get rights and content

Abstract

This paper discusses the evidence for parenting skills training and behavioral family intervention (BFI), and the need for early intervention and prevention programs. It presents a conceptual framework for a comprehensive multilevel parenting and family support strategy for reducing the prevalence of parenting difficulties and other family risk factors associated with child maltreatment and the development of behavioral and emotional problems in children and adolescents. The framework for the system of intervention known as the Triple P—Positive Parenting Program (Triple P) is described. Also discussed are issues in the dissemination of evidence-based psychological interventions. A dissemination approach is presented which is based on a systems-contextual perspective that views practitioner uptake as being influenced by a range of program design, training, quality maintenance, organizational and motivational variables. Our experience in the widespread dissemination and implementation of Triple P at a population-level are shared and recommendations and future directions for dissemination of evidence-based preventive family interventions are noted.

Section snippets

The relevance of behavioral family intervention

Poor discipline practices and lack of parental monitoring have been shown to account for up to 50% of the variance in criterion measures of child antisocial behavior (Forgatch, 1991). Parenting practices may also mediate the effects of other contextual factors such as social isolation, daily stress, parental depression, relationship conflict and social disadvantage on child behavior problems (Patterson et al., 1993, Patterson et al., 1992). There is also increasing recognition of the influence

Effective interventions do not equal population impact

Despite the evidence for the efficacy of BFI, and the trend for managed care and cost-effective practice (Task Force, 1995), the accessibility of empirically supported interventions is typically poor (Barlow & Hofmann, 1997) as the use of these empirically supported interventions in clinical practice is not widespread (Wilson, 1995). Families presenting to agencies that provide intervention services for children and families commonly do not receive BFI (Taylor & Biglan, 1998). Only the minority

The need for prevention and early intervention

For many years, there has been a call for an organized systemic revision of service provision, with prevention as the foundation of a hierarchy of child and family services (McClellan & Trupin, 1989). The Ottawa Charter for Health Promotion (World Health Organization and Canadian Public Health Association, 1986) provided a framework for public policy to have an increased focus on prevention and early intervention. Prevention has since been advocated as a key strategy for producing a significant

Dissemination of evidence-based prevention and early intervention programs

The overall aim of dissemination is concerned with the effective management of knowledge. It involves the transfer of knowledge about how to successfully plan, implement and evaluate family intervention and prevention programs, communicate the outcomes in both scientific and clinical arenas (including service providers, agencies and policy makers), and support the adoption of evidence-based approaches. Effective dissemination can avoid re-inventing the wheel and minimize the promotion of

Dissemination of the Triple P—Positive Parenting Program

To reduce community prevalence rates of family conflict and dysfunctional parenting practices, and therefore emotional and conduct problems in children and adolescents, we contend that a population approach addressing the broader ecological context of parenting (e.g., Biglan, 1995, National Institute of Mental Health, 1998) as well as the knowledge, skills and confidence of parents is required.

Recommendations for dissemination of evidence-based interventions

Our experience with Triple P has convinced us that a carefully planned strategy can lead to the successful dissemination of evidence-based programs. As the program has evolved, it has been clear that the strategies used to disseminate the program to the field require careful ongoing empirical scrutiny, with key considerations for dissemination efforts as follows:

Conclusions

There is strong empirical support for BFI as an evidence-based parenting and family support strategy (Patterson et al., 1992, Sanders, 1999, Taylor & Biglan, 1998), however, much of this support stems from efficacy research, with little research into effectiveness or clinical utility (Taylor & Biglan, 1998). Many programs evaluated and supported through scientific rigor are not well disseminated following successful research trials. Despite the notion that BFI may be the most effective

References (102)

  • R.G. Acton et al.

    Preliminary results of aggression management training for aggressive parents

    Journal of Interpersonal Violence

    (1992)
  • M.E. Addis

    Evaluating the treatment manual as a means of disseminating empirically validated psychotherapies

    Clinical Psychology: Science and Practice

    (1997)
  • S.T. Azar

    A cognitive behavioural approach to understanding and treating parents who physically abuse their children

  • T.E. Backer et al.

    Dissemination and adoption of innovative psychosocial interventions

    Journal of Consulting and Clinical Psychology

    (1986)
  • D.M. Baer et al.

    Some current dimensions of applied behavior analysis

    Journal of Applied Behavior Analysis

    (1968)
  • A. Bandura

    Social learning theory

    (1977)
  • D.H. Barlow et al.

    Efficacy and dissemination of psychological treatments

  • D.M. Becker et al.

    Health behavior research in minority populations: Access, design and implementation

    (1992)
  • A. Biglan

    Translating what we know about the context of antisocial behavior into a lower prevalence of such behavior

    Journal of Applied Behavior Analysis

    (1995)
  • P. Bower et al.

    The treatment of child and adolescent mental health problems in primary care: A systematic review

    Family Practice

    (2001)
  • R.W. Chamberlin

    Preventing low birth weight, child abuse, and school failure: The need for comprehensive, community-wide approaches

    Pediatrics in Review

    (1992)
  • S. Connell et al.

    Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas

    Behavior Modification

    (1997)
  • P. Crits-Christoph et al.

    Training in empirically validated treatments: What are clinical psychology students learning?

    Professional Psychology, Research and Practice

    (1995)
  • M.R. Dadds et al.

    The generalization of treatment effects in parent training with multidistressed parents

    Behavioural Psychotherapy

    (1987)
  • M.R. Dadds et al.

    Marital discord and treatment outcome in behavioral treatment of child conduct disorders

    Journal of Consulting and Clinical Psychology

    (1987)
  • W.C. Folette et al.

    Beyond the ivory tower but within the data: Issues in treatment dissemination

  • R.L. Forehand et al.

    Helping the noncompliant child: A clinician's guide to parent training

    (1981)
  • M.S. Forgatch

    The clinical science vortex: A developing theory of antisocial behavior

  • J. Glanville et al.

    Getting research findings into practice: Finding information on clinical effectiveness

    British Medical Journal

    (1998)
  • C. Glisson

    The organizational context of children's mental health services

    Clinical Child and Family Psychology Review

    (2004)
  • D. Gross et al.

    Parent training of toddlers in day care in low-income urban communities

    Journal of Consulting and Clinical Psychology

    (2003)
  • J.H. Grych et al.

    Marital conflict and children's adjustment: A cognitive-contextual framework

    Psychological Bulletin

    (1990)
  • K.W. Halford et al.

    Self-regulation in behavioral couples' therapy

    Behavior Therapy

    (1994)
  • B.M. Hart et al.

    Meaningful differences in the everyday experience of young American children

    (1995)
  • S.W. Henggeler et al.

    Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination

    Journal of Consulting and Clinical Psychology

    (1997)
  • E.L. Holloway et al.

    Supervision: Its contributions to treatment efficacy

    Journal of Consulting and Clinical Psychology

    (1995)
  • J.E. James

    Foundation education as a means for disseminating behavioural innovation to nonpsychologists

    Behaviour Change

    (1994)
  • P. Karoly

    Mechanisms of self-regulation: A systems view

    Annual Review of Psychology

    (1993)
  • D.J. Kavanagh et al.

    Application of cognitive–behavioural family intervention for schizophrenia in multidisciplinary teams: What can the matter be?

    Australian Psychologist

    (1993)
  • A.E. Kazdin

    Effectiveness of psychotherapy with children and adolescents

    Journal of Consulting and Clinical Psychology

    (1991)
  • A.E. Kazdin

    A model for developing effective treatments: Progression and interplay of theory, research, and practice

    Journal of Clinical Child Psychology

    (1997)
  • G. Kok

    Why are so many health promotion programs ineffective?

    Health Promotion Journal of Australia

    (1993)
  • Markie-Dadds, C., & Sanders, M. R. (submitted for publication). Self-directed Triple P—Positive Parenting Program for...
  • J. McClellan et al.

    Prevention of psychiatric disorders in children

    Hospital and Community Psychiatry

    (1989)
  • R.J. McMahon et al.

    Family-based intervention in the Fast Track Program

  • R.J. McMahon et al.

    Conduct problems

  • C.B. McNeil et al.

    Parent–child interaction therapy with behavior problem children: Generalization of treatment effects to the school setting

    Journal of Clinical Child Psychology

    (1991)
  • P. McTaggart et al.

    The Transition to School Project: Results from the classroom

    Australian e-Journal for the Advancement of Mental Health

    (2003)
  • J. Mintz et al.

    Efficacy and effectiveness of psychotherapy: Two paradigms, one science

    American Psychologist

    (1996)

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