Introduction: Parenting programs have been identified as a valuable service provision to promote quality parent-child relationships and attachment styles. The Triple P positive parenting program and the Circle of Security parenting (COS-P) program are evidence-based interventions designed to prevent behavioral and emotional problems in children. However, there is a lack of literature on the experiences of providers delivering these programs in the Canadian context. This study aimed to investigate and characterize these experiences through a mixed-methods approach. Methods: A total of 83 providers participated in the cross-sectional portion of the study, completing readiness measures prior to program implementation. The qualitative descriptive component of the study involved a sub-group of 22 providers in semi-structured focus groups, 12 months after program implementation. Descriptive measures were analyzed using R studio V. 4.2.0, while NVIVO Version 13 was used to manage the thematic analysis of the focus groups. The mixed-methods component involved an explanatory sequential approach, which involved integrating the data via a joint display table. Results: Organizational readiness involving training, supervision, and support were crucial for program delivery. Barriers identified included a lack of support, overwhelming workload, difficulty engaging parents, and program-specific barriers, while facilitators included positive experiences with training, teamwork, confidence, virtual delivery, and managerial support. Discussion: The results suggest that organizational readiness is crucial to the successful delivery of these programs. Providers require training, supervision, and ongoing support to deliver these interventions effectively. Additionally, barriers and facilitators in the delivery of these programs were identified, which can inform future program implementation and improve outcomes. Conclusion: This study provides valuable insights for organizations and providers to effectively deliver parenting programs like Triple P and COS-P by addressing barriers and facilitators of delivery, which can consequently improve parent-child relationships and attachment styles. / Thesis / Master of Public Health (MPH) / Effective delivery of evidence-based parenting programs is essential to promoting positive health outcomes for children and families. Unfortunately, very little research has investigated the experiences of providers delivering these programs. Due to this, our study applied a mixed methods approach that involved 83 providers who completed various readiness measures prior to program implementation, and 22 providers who participated in follow-up focus groups, 12 months after program implementation. The results of our study determined that organizational readiness, which is inclusive of training, supervision, and support, is critical to successful program delivery. Furthermore, we were able to identify barriers and facilitators of program delivery, which can inform future implementation efforts and improve program quality, while promoting positive outcomes for parents and children. This study provides unique insights into the experiences of parenting program providers in Canada and can serve as a tool to inform future program implementation and delivery efforts.

Abstract The primary focus of this research project was an evaluation of the Group Stepping Stones Triple P parenting program for parents of a child with a disability. In addition there was an investigation into the similarities and differences in child behaviour and parenting experience, and program outcomes, for families of children with different developmental disabilities. While the Triple P Positive Parenting Program has an impressive evidence base (Sanders, 1999; Sanders, Markie-Dadds, Tully & Bor, 2000) and research indicates that the standard Stepping Stones Triple P Program is efficacious for different disability groups (Roberts, Mazzucchelli, Studman & Sanders, 2006) and for parents of children with Autistic Spectrum Disorders (Whittingham, Sofronoff, Sheffield & Sanders, 2009), to date the group version of Stepping Stones Triple P has not been comprehensively evaluated, nor the efficacy of the program evaluated when administered concurrently to parents of children with different developmental disabilities. Currently, there is a lack of participant-friendly, evidence-based group parenting programs that can be utilised in a cost-effective manner with all parents of children with disabilities. Many interventions have been designed specifically to cater to the requirements of a particular disability group. While there is some divergence in disability characteristics and in the experience of families of children with different disabilities, there is compelling evidence that many of the most challenging experiences faced by parents of disabled children (such as emotional and behavioural disturbance and delays in skill development) are shared by many disability populations (Raina et al., 2005; Bourke et al., 2008). Consequently there is empirical support for the implementation of a broad, skill-based parenting program for all parents of children with disabilities. The first study in this research project was a randomised controlled trial the Group Stepping Stones Triple P program for parents of children with Autism Spectrum Disorders (ASD), Down syndrome, other intellectual disabilities and Cerebral Palsy. Fifty-two families were included in this trial and were randomly allocated to treatment and wait-list control groups. The results demonstrate significant improvements in child behaviour and parenting difficulties that were maintained at follow-up six months later. For over a third of participants the change in child behaviour and parenting styles was clinically reliable (Jacobsen & Truax, 1991; Evans, Margison & Barkham, 1998). In addition, the majority of parents reported the attainment of their program goals following the intervention. The second study was a comparison of program outcomes for parents from different disability groups. The sample was divided into two groups; parents of children with ASD and parents of children with intellectual and physical disabilities. The results demonstrated significant improvements in child behaviour and parenting difficulties from pre- to post-intervention for both the ASD group and the Intellectual and Physical disability group. For a third of parents in the ASD group and over a third of parents in the Intellectual and Physical disability group, the changes were clinically reliable (Jacobsen & Truax, 1991; Evans et al., 1998). In addition, the means for both groups on the child behaviour, parenting style and parental psychological functioning variables were compared. The results indicated that there were some differences in child behaviour, parenting styles and parent distress between the two groups, and in the program goals set by parents. However, overall the results revealed no systematic differences in treatment outcomes across disability groups, demonstrating that the program was effective for families of children with ASD and families of children with Intellectual and Physical disabilities. Finally, a series of three case evaluations were conducted to examine program outcomes and differences in child behaviour and parenting experiences for the families of a child with ASD, Down syndrome and Cerebral palsy. The results of the case studies revealed significant improvements in child behaviour and parenting styles for all three families, along with high levels of program satisfaction and successful attainment of parenting goals. For all three families these changes in child behaviour and parenting style were clinically reliable (Jacobsen & Truax, 1991; Evans et al., 1998) and maintained at six-month follow up. The results also provided information about the similarities and differences in parenting experiences, child behaviour and program goals across the three disabilities. Overall, this research project has demonstrated that the Group Stepping Stones Triple P program is an effective parenting intervention for challenging behaviour and dysfunctional parenting in families of children with a range of developmental disabilities. The results of this research provide evidence to suggest that mixed disability group format used in the administration of the Group Stepping Stones Triple P program did not preclude positive program outcomes. Finally, the results of this research project indicate that there are many shared parenting experiencing across families of children with different disabilities and that regardless of observed differences in disability characteristics and family experiences, the Group Stepping Stones Triple P program is sufficiently flexible and comprehensive in its scope to meet the needs of families from different disability populations.

In this thesis the intricacies of service user and staff perceptions of psychological interventions for mental health difficulties were explored. Expanding upon this theme, mothers and staff on a Mother and Baby Unit (MBU) were asked about their views regarding the acceptability and feasibility of the implementation of a parenting intervention, Baby Triple P Positive Parenting Programme (Baby TP). This investigation is presented as four papers: a literature review, two empirical papers (a & b) and, a critical review and personal reflection of the research process.The literature review, a meta-synthesis of qualitative studies, explores service user and staff perceptions of psychological interventions for mental health difficulties. Twenty-eight studies were synthesised to develop comprehensive understanding of subtle, specific and overlapping elements involved in the implementation of psychological intervention. Guided by Noblit and Hare’s (1988) approach, 11 over-arching themes and 25 sub-ordinate themes emerged from the synthesis. Findings provide a detailed description of the concepts pertinent to both service users and staff. Implications are identified for service managers and clinicians in obtaining optimum efficiency and outcomes of psychological intervention. The empirical study is a Q-methodological investigation into service user and staff perceptions of the acceptability and feasibility of a parenting intervention, Baby TP, on a MBU. This study is split into two population-specific papers. Overall five main factors were identified (service users: three; staff: two), which provides new insights into the acceptable and feasible elements of a parenting intervention within this specialist setting. The findings highlight a positive consensus as to the acceptability and feasibility of Baby TP in a MBU setting alongside a number of identified needs pertinent to service users, staff and the setting. Clinical implications and recommendations are provided to address identified areas of need for both populations within this setting. The third paper is a critical review of the thesis illustrated through personal reflections of the research process.

Cette étude vise à déterminer si la capacité de deux consortiums de partenaires à offrir un programme à données probantes (PDP) se développe au cours du processus d’implantation à l’aide d’un devis prétest-posttest sans groupe de comparaison. Elle vise également à tracer un portait de la capacité des consortiums. Le programme en question est Triple P – Positive Parenting Program. Vingt membres du personnel d’encadrement impliqués dans l’offre de Triple P ont rempli un questionnaire avant l’implantation et deux ans plus tard. Ce questionnaire mesure leurs perceptions quant à diverses variables reflétant plusieurs dimensions de la capacité : les aspects organisationnels susceptibles de faciliter ou de nuire à l’implantation pour les participants, le degré de préparation des organisations à implanter Triple P, le fonctionnement du partenariat mobilisé autour de Triple P et les impacts du partenariat au niveau individuel, organisationnel et communautaire. Des analyses de variances multivariées (MANOVAs) à meures répétées ont été effectuées afin de comparer les deux temps de mesure et faire ressortir les forces et les faiblesses des consortiums. Les résultats n’indiquent pas de changement statistiquement significatif entre les deux temps de mesure. Toutefois, on remarque, pour certaines variables, des tailles d’effet de moyenne et grande amplitude, dans le sens d’un développement de la capacité. Ainsi, il est probable que le processus pour offrir Triple P ait eu un impact sur la capacité des milieux, mais le petit échantillon ferait en sorte que la puissance statistique est insuffisante pour le détecter. Un portrait de la capacité au posttest est tracé et des recommandations sur les dimensions à perfectionner sont fournies. Entre-autre, plus d’efforts sont nécessaires pour obtenir suffisamment de ressources, avoir un partenariat synergique ainsi que pour que la communication, les formations et l’environnement organisationnel soient adaptés pour offrir le programme.