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Group Teen Triple P – Level 4

A group parent training program designed to improve parenting skills, manage family problems, and enhance positive family relationships, ultimately to prevent problem behavior among youth.

Program Outcomes

  • Close Relationships with Parents
  • Conduct Problems

Program Type

  • Parent Training

Program Setting

  • Community

Continuum of Intervention

  • Selective Prevention
  • Universal Prevention

Age

  • Early Adolescence (12-14) - Middle School

Gender

  • Both

Race/Ethnicity

  • All

Endorsements

Blueprints: Promising

Program Information Contact

Bradley Thomas
Chief Executive Officer
Triple P America, Inc.
Head Office Address: 1201 Lincoln Street, Suite 201, Columbia, SC 29201
Postal Address: PO Box 12755, Columbia, SC 29211
Phone: (803) 451-2278 x204
Email: brad.thomas@triplep.net
Web: www.triplep.net

Program Developer/Owner

Matthew Sanders, Ph.D.
The University of Queensland


Brief Description of the Program

Group Teen Triple P - Level 4 consists of four 2-hour group sessions, delivered over 8 weeks, with up to 12 parents of teenage adolescents. The sessions provide opportunities for parents to gain knowledge and skills for reducing parent-child and marital conflict, depression, and high levels of parenting stress that can lead to negative outcomes in young adults. Parents learn new skills through a process of observation, discussion, practice, and feedback, and between sessions complete homework tasks designed to reinforce the content of the group sessions.

Outcomes

Compared to controls, the treatment group improved:

  • Adolescent and parent-reported problem behavior
  • Both adolescent and parent-reported measures of positive child-parent relationships

Improvements to risk and protective factors:

  • Family Conflict
  • Family Cohesion
  • Parent Self-Efficacy
  • Family Management

Brief Evaluation Methodology

Families with a child between the ages of 12 and 15 were recruited using a community outreach approach in Auckland, New Zealand. Though both parents in intact families were encouraged to participate, only mothers' assessment data was used. In total, 72 families completed baseline measures before being randomly assigned to treatment or control conditions. Most families (96%) were assessed at posttest, 10 weeks later, and 81% were retained at 6-month follow-up.

Study 1

Chu, J. T. W., Bullen, P., Farruggia, S. P., Dittman, C. K., & Sanders, M. R. (2015). Parent and adolescent effects of a universal group program for the parenting of adolescents. Prevention Science, 16(4), 609-620.


Risk Factors

Individual: Favorable attitudes towards antisocial behavior

Family: Family conflict/violence*, Parent stress, Poor family management*

Protective Factors

Individual: Prosocial behavior

Family: Parent social support*


* Risk/Protective Factor was significantly impacted by the program

See also: Group Teen Triple P - Level 4 Logic Model (PDF)

Race/Ethnicity/Gender Details

The study did not examine racial/ethnic or gender subgroup impacts of the intervention.

Note: Triple P does not use a train-the-trainer model.

Pre-requisite training

There is no pre-requisite Triple P training required to attend Group Teen Triple P. However, training in Group Teen Triple P is available as a shorter extension course to practitioners who have previously completed certain Triple P Provider Training Courses. Please contact TPA for further details.

However, prior experience in working with adolescents and families and a desire to learn and implement the model are essential. Implementation sites may have additional criteria layered on this, required by local jurisdictions.

Training

The Training Course is conducted over three days. The course covers the theoretical foundations of behavioral family interventions both generally and specific to Group Teen Triple P. Group Teen Triple P is a broad-focused parenting program suitable for parents with multiple concerns around teenagers' behavioral problems. The program is delivered in a small group format. Practitioners learn assessment skills, parenting strategies used in Triple P, group process skills, how to deal with resistance, answering parent questions, and conducting telephone consultations. Additionally, a comprehensive overview of the development and prevalence of behavioral and emotional problems in adolescents is presented. Each practitioner receives Participant Notes and practitioner resources. A skills-based training approach is used to introduce participants to the range of consultation skills necessary for effective delivery of the program. Various teaching methods are used, including instructive presentation, video demonstration, clinical problem solving, rehearsal of consultation skills, feedback and peer tutoring.

Accreditation
Accreditation is scheduled six to eight weeks after the training has been completed. To maximize opportunities for individualized attention, accreditation workshops are restricted to small groups of 5 to 10 practitioners per session and for Group Teen Triple P are scheduled as half-day sessions (total of two days per Group Teen Triple P Training). At the accreditation workshops, practitioners will demonstrate their proficiency in the three competency areas targeted for Group Teen Triple P accreditation, and receive coaching and feedback on their performance. Practitioners will also complete a 30-question multiple-choice quiz between training and accreditation. Quizzes are marked during the accreditation day.

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.

Start-Up Costs

Initial Training and Technical Assistance

The 2017 cost for an agency to train 20 practitioners (with the below inclusions) in Group Teen Triple P is USD $31,525, excluding any taxes. Taxes will be applied where appropriate. Costs are valid to 30 June 2018.

TRAINING INCLUSIONS:
Group Teen Triple P Provider Training (3 days) & Accreditation (2 days per group of 20 practitioners - each practitioner attends for a half-day accreditation session). The Accreditation follows 6-8 weeks after the initial Provider Training.
Participant Notes and Training & Accreditation Evaluation Booklets for Group Teen Triple P.
Facilitator's Kit for Group Triple P, including

  • 1 x Facilitator's Manual for Group Teen Triple P
  • 1 x Teen Triple P Group Workbook
  • 1 x Group Teen Triple P Presentation Slides (CD)
  • 1 x Every Parent's Guide to Teenagers (DVD).

A Pre-Accreditation Workshop (1 day) is required for this training course. The 2017 cost for 20 practitioners is USD $3,630, excluding any taxes.

The host organization will need to provide:

  • An appropriate training venue to accommodate 20 people behind tables in a U-shape (minimum 20 x 26 feet, centrally air-conditioned/heated with a breakout space for small group activities).
  • Catering for practitioners ensuring dietary requirements are met, if necessary.
  • Data projector, screen, and speakers for a PowerPoint Presentation and screening of a DVD.
  • Whiteboard or flip chart with markers.

Note: Generally, there is no cost in hiring a training venue as agencies typically provide a space within their organization's building or at another agency willing to provide space in their community.

There may be additional costs related to practitioner travel for training, accreditation and support days if the practitioner is traveling to the events from far away.

The time investment by practitioners to familiarize themselves with the program and prepare for accreditation (in addition to attending training, pre-accreditation workshop, and accreditation) is approximately 10 hours.

FOR SMALLER ORGANIZATIONS:
Open Enrollment (OE) Triple P Provider Training Courses are available in multiple locations annually and are recommended for organizations training fewer than 10 practitioners. OE trainings can be a more cost-effective option if the required practitioner numbers are low. However, they are organized on demand, which results in less flexibility in terms of the levels on offer and the available dates. Please contact your local office for a copy of the OE schedule and costs or visit the Open Enrollment page at www.triplep.net.

Curriculum and Materials

Curriculum: Included in Training Costs

Materials: Group Teen Triple P workbook - $28.50 exclusive of taxes, 1 per family (Additional copies for other family members are optional.)

Licensing

None.

Other Start-Up Costs

Triple P America (TPA) uses an implementation and sustainability framework to assist and support implementing organizations and communities (Triple P Implementation Framework; McWilliam, Brown, Sanders & Jones, 2016). Foundational support is provided by a Triple P Implementation Consultant free of charge. Additional consultation and/or tailored support can be determined by TPA and the implementing organization.

OPTIONAL:

A Triple P Briefing is often the first step in the early stages of the implementation process and is strongly recommended for organizations new to the Triple P system. Designed to outline the Triple P system (e.g. levels of intervention, training programs, service delivery options, implementation and sustainability factors), they help organizations inform managers, decision makers, supervisory staff, and practitioners about the Triple P system. The 2017 cost for a Triple P Briefing is USD $3,630, excluding any taxes. Taxes will be applied where appropriate. Costs are valid to 30 June 2018.

Intervention Implementation Costs

Ongoing Curriculum and Materials

Group Teen Triple P Workbook - 1 per family - $28.50 exclusive of taxes.

Staffing

Triple P is designed to train an existing workforce to deliver the program to parents.

In addition to the practitioner, other positions may include program manager, data entry clerk, quality assurance or program evaluation for larger roll-outs.

A suitably qualified and experienced person should be appointed as program coordinator within the organization.

Other Implementation Costs

Program delivery guidelines to consider, based on one practitioner delivering the group:

  • Parent contact = 10 hours (2 hours per session for 5 weeks)
  • Questionnaire scoring = 5 hours (30 minutes per family; 10 families on average per group)
  • Telephone and in-person support = 15 hours (30 minutes per family each week for 3 weeks; 10 families on average per group)
  • Preparation and post-session debrief/supervision = 5 hours
  • Case notes and report writing = 5 hours (30 minutes per family; 10 families on average per group)

For a group of 10 families, total practitioner time required would be = 40 hours over 5 weeks (i.e., 4 hours per family).

PROVIDED AT NO ADDITIONAL COST:
Practitioners and organizations can use the web-based Triple P Automatic Scoring and Reporting Application (ASRA) on the Triple P Provider Network to electronically score the questionnaire data they collect when working with families. The Triple P ASRA has been developed to assist practitioners and organizations with entering and scoring data simply and efficiently, as well as with program evaluation and reporting.

Note: The use of ASRA can reduce the time spent on questionnaire scoring.

Agencies/organizations are encouraged to set up peer support groups for their Triple P providers. Individual providers are encouraged to attend peer support groups (in-person or via teleconference when necessary). These peer support groups provide practitioners an opportunity to discuss their current Triple P cases, as well as common process issues that may arise for the group as a whole. It is recommended that practitioners use the self-regulatory approach in discussion of cases and process issues.

OPTIONAL:
The Stay Positive communications strategy (including associated materials) is available to explain Triple P to parents in the community and to help destigmatize the notion of asking for parenting help. Stay Positive costs will vary depending on the organization's communications plan and needs. Costs can be estimated through conversations with TPA.

PROVIDED AT NO ADDITIONAL COST:
On completion of the Triple P Provider Training, practitioners gain access to the web-based Triple P Provider Network, which is one avenue of continued support following training. This password-accessed website supports trained Triple P practitioners working in the field. It provides helpful advice about the delivery of the program and access to a range of clinical resources.

Space requirements:
The program delivery venues should have a room large enough to comfortably seat 12 participants, movable chairs and a table for audio-visual equipment. There should be access to a large TV monitor, projector and screen, and a whiteboard, blackboard or easel with butcher's paper and pens. Practitioners typically deliverer the program in their organization's venue or a community agency such as a library, recreation center, faith-based organization, childcare center or school. These venues are typically easy for parents to access and are unlikely to have a cost for venue hire.

Other optional:
Some organizations provide parents with transport, tea and coffee, child care, or other supportive measures to help families attend the sessions.

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

OPTIONAL:
Half-day professional development workshops are available in a range of topics.

Clinical Support Days are available to provide an opportunity for practitioners to meet with fellow practitioners to discuss cases, problem solve, plan for future delivery, and receive expert feedback for professional development. This is also available through telephone support.

Fidelity Monitoring and Evaluation

All Triple P programs are structured around robust resources that guide the practitioner to deliver programs in a consistent and coherent way. These include manuals for the practitioner with comprehensive session guides, video examples to be shown to parents at pre-determined times during each program, and parent workbooks and tip sheets that provide exercises and discussions designed to ensure parents receive the programs as they were designed and evaluated.

Session checklists are provided for each Triple P intervention and can be utilized by practitioners to monitor their own fidelity to the program, and agencies/organizations that are leading Triple P rollouts in communities may also collect these measures from practitioners as a measure of fidelity to the program. Practitioners and organizations are encouraged to use the checklists to assist in their self-regulation and continuous quality improvement.

Agencies are also encouraged to identify local sources of expertise in conducting independent evaluations of program outcomes on a larger scale. Triple P America does not typically undertake such evaluations but can assist in identifying suitable research groups if requested.

Ongoing License Fees

No information is available

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

The potential reach of the program is largely dependent upon the capacity for practitioners to deliver the program. Practitioner productivity standards and organizational staff attrition rates contribute to the overall long-term costs considerations. One of the easiest ways for organizations to maximize their investment is to retain their highly-trained staff and set productivity standards.

Year One Cost Example

This example is for a larger organization; smaller organizations with fewer than 10 practitioners will need to contact Triple P directly for expense estimates.

In this example, an agency uses 20 practitioners to deliver Group Teen Triple P - Level 4 to families in the community. Each practitioner delivers the program 3 times during the year to groups of 10 families each. Thus, each practitioners serves 30 families and the agency collectively serves 600 families in the first year. The agency uses it own facilities and equipment for program delivery.

The costs provided below exclude taxes which will be applied where appropriate. Costs are valid through June 30, 2018.

Pre-Accreditation: 20 practitioners $3,630.00
Provider Training & Accreditation: 20 practitioners $31,525.00
Teen Triple P Group Workbook: 600 @ $28.50 (excludes shipping and handling) $17,100.00
Total One Year Cost $52,255.00

In the Year 1, the agency serves 600 families at a cost of $87.09 per family. In subsequent years, the program cost would be substantially reduced if the agency maintains its trained staff.

Funding Overview

No information is available

Funding Strategies

Improving the Use of Existing Public Funds

No information is available

Allocating State or Local General Funds

State and local funding has been used to support many components of Triple P. Vehicle license fees, tobacco taxes, and other state laws have been instrumental in funding evidence-based programs such as Triple P. Local school districts may also have discretionary funds available to advance student success and student health services. Schools are an ideal setting for Triple P services to be delivered and as educational institutions become trauma-informed, additional support may be found there. State Innovation Model funding may also be accessed by knowledgeable hospitals and primary care clinics, which are able to link public health approaches such as Triple P with the goals of population health and the Triple Aim. Existing funding mechanisms for community clinics and federally qualified health centers also provide a route for state reimbursement of the most intensive Triple P services. It is important to approach Triple P funding with a willingness to explore options broadly.

Maximizing Federal Funds

Formula Funds: Title I grants to school systems have been used to train teachers and counselors in Triple P. TANF and Title IV-B social services funding can be used for training and interventions through parenting programs.

Discretionary Grants: Discretionary grants from the federal government can be sought from a wide array of federal agencies, including the Departments of Education, the Centers for Disease Control, National Institutes of Health, Centers for Medicare and Medicaid Services and the WIC Program. A wide-ranging review of federal grant opportunities will be important for sites considering Triple P. It is important for agencies to monitor government FOAs across HHS because many agencies may have categorical programs that can be applied to Triple P programming. This is especially true for divisions with ancillary public health missions.

Entitlements: Triple P has been funded with Medicaid, Title IV-E, and Title V dollars. Medicaid is used to fund Triple P when offered as a health, mental health, or case management service. Direct Title IV-E dollars as well as waivers to states and counties have supported direct practitioner training costs for child welfare workers and indirect administrative costs related to coordinating training. Triple P America has developed a Title IV-E toolkit to assist jurisdictions in navigating the IV-E reimbursement process. Title I, II, IV of the ESSA (re-authorizing ESEA), present opportunities for jurisdictions to fund Triple P services through a variety of school-based initiatives.

Foundation Grants and Public-Private Partnerships

Many foundations and United Ways support Triple P. With the many different targets of the Triple P intervention, interest can be garnered from a variety of foundations, especially those with priorities including child abuse, health and mental health care, violence prevention and parenting education. Triple P seeks to link its network of direct service providers with educational institutions and public agencies which have the capacity to develop research and service provision proposals. Because members of the Triple P community have expertise in basic research, clinical research, and public sector administration, public-private partnerships are seen as desirable and key in building a sustainable system within jurisdictions.

Debt Financing

Debt financing is a source of funding for initial implementation of Triple P. This is particularly effective when the program targets a population at risk of an expensive remedial intervention in the absence of Triple P.

Generating New Revenue

New revenue can be useful for both start-up costs and sustaining Triple P, particularly when the intervention desired does not have an already existing funding source. A range of approaches can be considered, from fund raising efforts to excise taxes to tax form check-offs and children's trust funds. An openness to exploring new options for realizing new revenue should be brought to the effort. In this regard, healthcare reform initiatives present opportunities for jurisdictions to pilot programs that increase cost efficiencies and quality of care.

Data Sources

No information is available

Program Developer/Owner

Matthew Sanders, Ph.D.DirectorThe University of QueenslandParenting and Family Support CenterSchool of PsychologySchool of PsychologyBrisbane, QLDBrisbane, QLD4072Australia61 (7) 3365 7290info@triplep.net www.pfsc.uq.edu.au/

Program Outcomes

  • Close Relationships with Parents
  • Conduct Problems

Program Specifics

Program Type

  • Parent Training

Program Setting

  • Community

Continuum of Intervention

  • Selective Prevention
  • Universal Prevention

Program Goals

A group parent training program designed to improve parenting skills, manage family problems, and enhance positive family relationships, ultimately to prevent problem behavior among youth.

Population Demographics

The program targets parents of teenage youth aged 12-15 and, through the parents, teens themselves.

Target Population

Age

  • Early Adolescence (12-14) - Middle School

Gender

  • Both

Race/Ethnicity

  • All

Race/Ethnicity/Gender Details

The study did not examine racial/ethnic or gender subgroup impacts of the intervention.

Risk/Protective Factor Domain

  • Individual
  • Family

Risk/Protective Factors

Risk Factors

Individual: Favorable attitudes towards antisocial behavior

Family: Family conflict/violence*, Parent stress, Poor family management*

Protective Factors

Individual: Prosocial behavior

Family: Parent social support*


*Risk/Protective Factor was significantly impacted by the program

See also: Group Teen Triple P - Level 4 Logic Model (PDF)

Brief Description of the Program

Group Teen Triple P - Level 4 consists of four 2-hour group sessions, delivered over 8 weeks, with up to 12 parents of teenage adolescents. The sessions provide opportunities for parents to gain knowledge and skills for reducing parent-child and marital conflict, depression, and high levels of parenting stress that can lead to negative outcomes in young adults. Parents learn new skills through a process of observation, discussion, practice, and feedback, and between sessions complete homework tasks designed to reinforce the content of the group sessions.

Description of the Program

Group Teen Triple P - Level 4 consists of four 2-hour sessions, delivered over 8 weeks, in groups of up to 12 parents. Parents actively participate in a range of exercises to learn about the causes of adolescent behavior problems, setting specific goals, and using strategies to promote a teenager's skills development, manage inappropriate behavior and teach emotional self-regulation.

Specifically, during group sessions parents are coached in a variety of behavior management skills including: monitoring problem behavior; providing brief contingent attention following desirable behavior; arranging engaging activities; using directed discussion for minor problem behavior; making clear, calm requests; and backing up instructions with logical consequences. For more difficult or well-established adolescent behavioral problems, parents learn to use family meetings, and behavior contracts to make necessary changes to family routines.

Sessions Cover:

Session 1: Positive parenting. This session provides parents with an introduction to positive parenting, factors that influence teenagers' behavior, and how to set goals for change. Parents submit a completed assessment booklet at the beginning of this session.

Session 2: Encouraging appropriate behavior. During this session, the practitioner discusses how to develop positive relationships with teenagers, increase desirable behavior, teach new skills and behaviors, use behavior contracts, and hold family meetings.

Session 3: Managing problem behavior. In this session, parents learn how to develop family rules, deal with non- cooperation, acknowledge emotions, and use behavior contracts. They have an opportunity to rehearse these routines in the session, to promote emotional self-regulation.

Session 4: Dealing with risky behavior. This session covers identifying risky situations, routines to deal with risky behavior, and family survival tips. Parents also prepare for their individual consultation sessions.

Session 5-7: Implementing parenting routines 1-3. The practitioner provides feedback from initial assessments that the family completed and then uses a self-regulatory feedback model to assist parents to review their implementation of parenting strategies and risky behavior plans. From this, parents set goals for the further refinement of their routines, if needed.

Session 8: Program close. Parents return for a final group session to review progress and family survival tips, look at ways to maintain changes and problem-solve for the future, and to close the program. If necessary, referral options are discussed.

Theoretical Rationale

Teen Triple P is based on social learning principles, with a strong emphasis placed on parents acknowledging and encouraging the growing autonomy and independence of their teenage children. The program is also skill-oriented, in that parents learn about and practice skills that are used to promote a healthier family environment.

Theoretical Orientation

  • Skill Oriented
  • Social Learning

Brief Evaluation Methodology

Families with a child between the ages of 12 and 15 were recruited using a community outreach approach in Auckland, New Zealand. Though both parents in intact families were encouraged to participate, only mothers' assessment data was used. In total, 72 families completed baseline measures before being randomly assigned to treatment or control conditions. Most families (96%) were assessed at posttest, 10 weeks later, and 81% were retained at 6-month follow-up.

Outcomes (Brief, over all studies)

The treatment group improved 13 of 22 outcomes across parent and youth reports at posttest and 6-month follow-up, compared to controls; however, some impacts were not maintained. Generally, the intervention group improved risk and protective factors related to fostering positive relationships between parents and children as well as parent and self-reported adolescent problem behavior.

Outcomes

Compared to controls, the treatment group improved:

  • Adolescent and parent-reported problem behavior
  • Both adolescent and parent-reported measures of positive child-parent relationships

Improvements to risk and protective factors:

  • Family Conflict
  • Family Cohesion
  • Parent Self-Efficacy
  • Family Management

Mediating Effects

Not assessed.

Effect Size

Effect sizes reported in Chu et al. (2014) were small (d =.14-.22), small-medium (d =.32-.41), and large (d = .71-1.10). These effect sizes, however, were overstated since the authors used the F-test to calculate effect sizes (a method largely used in meta-analyses when means and standard deviations are typically not reported). The authors therefore recalculated effect sizes using the standard formula (i.e. the adjusted condition differences from the ANCOVA divided by the pooled pretest standard deviation). The recalculated effect sizes (not reported in the article) were small (d =.00-.27), small-medium (d =.32-.38), medium (d =.42-.52), medium-large (d =.61-.67), and large (d =.75-1.26).

Generalizability

All participating families were recruited from Auckland, New Zealand, and appeared representative of families in that country.

Potential Limitations

  • Many measures came from parents, who helped deliver the program, but youth reports are also available.
  • Groups differed at baseline on only 1 of 22 measures, parent over-reactivity, but this is controlled in analysis.
  • No significance test for differential attrition by group or socioeconomic background. However, attrition was less than 5% at posttest, and at six-month follow-up there were no significant differences between completers and non-completers.

Endorsements

Blueprints: Promising

Program Information Contact

Bradley Thomas
Chief Executive Officer
Triple P America, Inc.
Head Office Address: 1201 Lincoln Street, Suite 201, Columbia, SC 29201
Postal Address: PO Box 12755, Columbia, SC 29211
Phone: (803) 451-2278 x204
Email: brad.thomas@triplep.net
Web: www.triplep.net

References

Study 1

Certified Chu, J. T. W., Bullen, P., Farruggia, S. P., Dittman, C. K., & Sanders, M. R. (2015). Parent and adolescent effects of a universal group program for the parenting of adolescents. Prevention Science, 16(4), 609-620.

Ralph, A., & Sanders, M. R. (2003). Preliminary evaluation of the Group Teen Triple P program for parents of teenagers making the transition to high school. Australian e-Journal for the Advancement of Mental Health, 2(3), 169-178.

Study 1

Evaluation Methodology

Design

Recruitment/ Assignment: Families with teenage children were recruited from Auckland, New Zealand using a community outreach approach in schools, media outlets, and public events. Eligible families had a child between 12 and 15 years old who did not have developmental or intellectual disabilities and whose parent was not receiving professional help for his/her own or the child's behavioral or emotional problems. While 107 parents were screened, 72 were deemed eligible, completed baseline assessments, and randomized to treatment (n= 35) or a care-as-usual control (n=37) condition.

Assessment: Parents completed measures at baseline, posttest (10 weeks post-baseline), and at 6-month follow-up. While both parents of intact families were encouraged to participate in the evaluations, only the mother's data was used. Most completed the posttest assessment (n= 69; 96% of baseline sample) and 81% (n= 58) were retained at 6-month follow-up, though the analysis used data from the full baseline sample.

Sample

Most mothers were married (67%), many to the father of their child (65%), with an average age of 45. More than half (52%) had a university degree and were currently employed (81%), with 35% earning more than the average New Zealand household income ($81,067) and 70% reporting no major difficulties paying for household expenses over the last year. The adolescents targeted by the intervention were mostly male (60%) and averaged 13 years of age. Relatively few were indigenous (10%) or belonged to other racial/ethnic minorities (17%).

Measures

Mothers completed 13 measures pertaining to parenting, parental relationships, parental adjustment, and adolescent problem behavior. Adolescents completed 9 measures on family relationships, adjustment, problem behavior, and parental monitoring. For testing, the parent-reported outcomes and the adolescent-reported outcomes were each treated as part of six conceptually related groups: 1) family relationship, 2) parental relationship, 3) parenting, 4) adolescent problem behavior, 5) adolescent adjustment, and 6) parental adjustment.

Family Cohesion and Conflict was assessed by both parents and children using 2 subscales, each containing 9 items, from the Family Environment Scale. Both measures demonstrated good reliability (a = .84, .83).

Parent-Adolescent Conflict was measured using 8 items from the Parent Conflict Questionnaire, and had high internal consistency for both mothers and adolescents (a = .82, .84).

Inter-Parental Conflict Over Child Rearing was measured with 16 items from the Parent Problem Checklist which provides an index of the number of disagreements and the severity these disagreements. Single mothers did not complete the measure. Both index frequency and severity had acceptable reliability (a = .82, .84).

Parent Relationship Satisfaction was assessed with 6 items from the Relationship Quality Index, which had very high internal consistency (a = .93).

Parent Laxness and Over-Reactivity came from an adaptation of the parent-reported Parenting Scale with 13 items. Reliability of the laxness measure was good (a = .89), but for over-reactivity was low (a = .61).

Parental Monitoring was assessed by parents and children using the Parental Monitoring Scale, with 8 items measuring how well parents keep track of their child's whereabouts. Parent and adolescent reports both had high consistency (a= .91).

Parent Self-Efficacy was measured from parent responses to 13 items from the 35-item Parental Self-Efficacy Scale. The reliability of the measure was good (a = .92).

Parent Depression and Stress were assessed using subscales from the Depression Anxiety Stress Scales-21. While anxiety was also measured it was not used, as reliability was considerably lower than for the other measures (a = .87 for depression, .83 for stress).

Adolescent Problems-Emotional, Conduct, Hyperactivity, & Peer were measured by parents and children using relevant 5-item subscales from the Strengths and Difficulties Questionnaire. The items were summed to create an overall score, which had acceptable reliability for both parents and adolescents (a = .79, .81).

Adolescent Problem Behavior was measured across multiple dimensions (e.g. school-related deviance, risk taking, substance use) with the 22-item Problem Behavior Checklist. The adolescent-reported measure had moderate internal consistency (a = .72).

Adolescent Autonomy in Decision-Making was assessed across 12 topical areas with the Autonomy Scale. The youth- eports had moderate reliability (a = .73).

Adolescent Self-Esteem was assessed using the 10-item Rosenberg Self-Esteem Scale, which demonstrated good consistency with the youth reporting (a = .89).

Adolescent Empathy was measured using the caring subscale from Positive Youth Development. The 9-items had moderate reliability (a = .75).

Analysis

Intervention effects were estimated using a series of multivariate and univariate analyses of covariance (MANOVA and ANCOVA). Separate models were used to assess posttest and longer-term impacts (at 6-month follow-up), with baseline outcomes as covariates, rather than adjusting for repeated measures. Many univariate tests (44) were performed without adjustment for multiple tests, though they were done in combination with the MANOVA tests for conceptually related groups of outcomes.

In accordance with intent-to-treat, the analyses appeared to use data from the full baseline sample regardless of treatment adherence, though the method for including missing data was mentioned only briefly. The authors stated that, "Expectation maximization was used to estimate values for the intent-to-treat sample."

Outcomes

Implementation Fidelity: While no figures were presented, the study states "facilitators completed session checklists to ensure treatment integrity and reduce protocol drift during the trial."

Baseline Equivalence: One pre-intervention difference was observed for parent over-reactivity, with the treatment group reporting higher levels than controls. The measure was controlled for in subsequent analyses.

Differential Attrition: Attrition was minimal (<5%) at posttest, but retention rates appeared to differ at 6-month follow-up (77%, treatment; 84%, control) and the difference did not appear to be tested for statistical significance. Also, there were no tests for attrition by sociodemographic background. However, "[a] series of one-way ANOVAs revealed no significant differences… between completers and non-completers at the 6-month follow-up on any of the dependent variables." In addition, missing values for the outcomes were found to be missing completely at random.

Posttest: For parent behavior at posttest, 7 of 12 tests for parent-reported measures and 4 of 4 tests for adolescent-reported measures reached statistical significance. Medium-large improvements were noted for parent and youth-reported parent-youth conflict and parental monitoring, and youth-rated family conflict and empathy and large impacts were noted for mother-reported family conflict, cohesion, laxness, over-reactivity, parenting self-efficacy, and youth-reported family cohesion. For parent behavior at the 6-month follow-up, the results were similar, with 5 of 12 tests for parent-reported measures and 4 of 4 tests for adolescent-reported measures reaching statistical significance.

For adolescent problem behavior and adjustment at posttest, 1 of 1 parent-reported measure and 0 of 5 adolescent-reported measures reached statistical significance. A large improvement (d = .90) was found for the parent-reported measure of total problems. At the 6-month follow-up, 1 of 1 parent-reported measure and 3 of 5 adolescent-reported measures reached statistical significance. The newly significant outcomes included two measures of adolescent-reported total problems and one measure of caring.

Contact

Blueprints for Healthy Youth Development
University of Colorado Boulder
Institute of Behavioral Science
UCB 483, Boulder, CO 80309

Email: blueprints@colorado.edu

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currently funded by Arnold Ventures (formerly the Laura and John Arnold Foundation) and historically has received funding from the Annie E. Casey Foundation and the Office of Juvenile Justice and Delinquency Prevention.