Teen Triple P is a behavioural family intervention for parents of adolescents. It is a multi-level intervention package that allows the strength and format of the intervention to be tailored to the needs of the family. Teen Triple P is available in three modalities: individual; group; and self-directed programs. This research investigated whether a self-directed program, Self-directed Teen Triple P, which consists of a parent workbook and video is sufficient to reduce risk factors known to be associated with the development of serious emotional and behavioural problems in adolescents and enhance protective factors. The present research sought to: a) determine the impact of a self-directed behavioural family intervention program on parents’ perceptions of their adolescent’s behaviour; b) assess the efficacy and consumer acceptance of a self-directed parenting intervention; c) identify clinical implications arising from this research to assist practitioners in the appropriate use of self-directed behavioural family intervention programs; and d) examine the psychometric properties of treatment outcome measures for use with adolescents and their parents. A central tenet of this research is the principal of sufficiency that is, examining the ability of a behavioural family intervention to produce desirable outcomes for adolescents and their parents under lowest intervention and cost conditions. Fifty-one Queensland families with children in Year 7 or 8, aged 11-14 years, were recruited from the community by means of flyers distributed to schools, newspaper and radio advertisements. Participants were randomly assigned to 1 of 3 conditions: (1) Standard self-directed Teen Triple P, a 10 module workbook program supplemented by a video; (2) Enhanced Self-directed Teen Triple P, the same program as Standard self-directed Teen Triple P, but included 10, 15-minute weekly telephone consultations with a Triple P therapist to assist in tailoring the program to meet the individual family’s needs; or (3) Waitlist control, a comparison group who initially only completed the measures, but later went on to do a replication of the standard intervention. The program was implemented with average recruitment (61%), and moderate attrition rate (23.5%). At post-intervention, using parent report measures of adolescent behaviour and parenting practices, parents in the enhanced condition reported significantly fewer adolescent behaviour problems and less use of dysfunctional parenting strategies than parents in the waitlist condition. Parents in the standard condition reported improvements in some areas but not as large or wide-spread as the enhanced group. Improvements were maintained at 3-month follow-up. There was no significant difference among conditions at post-intervention or follow-up on parents’ self-report measures of depression, anxiety, stress or relationship quality. The psychometric properties of measures of adolescent functioning, parenting style, relationship satisfaction and parental adjustment previously reported on different samples were confirmed. An underlying factor structure for the Parent Problem Checklist was identified and implications for its use discussed. Modifications to the scoring of the Consumer Satisfaction Questionnaire are discussed in the light of its factor structure. This research provides important information regarding the efficacy of a self-directed behavioural family intervention as an early intervention for families of early adolescents experiencing some problematic behaviour. It also provides some clinical implications of using self-directed interventions with families.

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.

This thesis presents a program of research evaluating the implementation of a primary care intervention program for disruptive child behaviour, and the process of dissemination of the intervention to primary care staff. The specific aims were to: 1) evaluate the effectiveness and acceptability of a brief, preventive behavioural family intervention (BFI) administered by primary care staff in improving parenting skills and confidence and reducing targeted child behaviour problems; 2) assess the process of disseminating the intervention to primary care professionals by evaluating aids and obstacles for program implementation in the workplace; and 3) provide recommendations for future dissemination of psychological interventions. Childhood disruptive behaviour problems are becoming increasingly prevalent and are associated with significant personal and societal costs. Much is now known about the development of such problems, including individual, family and social risk and protective factors. There is considerable evidence that BFI programs are effective in reducing child behaviour problems and the family risk factors associated with the development and maintenance of these problems. Unfortunately, many evaluated programs have not been disseminated effectively, and have primarily been provided to clinical or high-risk populations in efficacy trials. Primary care settings have been increasingly identified as ideal settings for detection and early intervention for child mental health problems. However, there is limited research in the area of primary care BFI. While dissemination of psychological innovation to psychologists has historically been poor, with little impact on the professional practices of practitioners in the field, documentation of dissemination of these interventions to non-psychologists is rare. Although dissemination and diffusion theory have expanded, there is little controlled research evaluating the necessary or optimal conditions for the adoption and ongoing implementation of evidence-based programs. To address the problem of poor dissemination and limited access to evidence-based parenting programs in the community, a multilevel parenting and family support initiative, the Triple P-Positive Parenting Program, has been developed at the University of Queensland. One level of this system, Primary Care Triple P, encompasses a preventively oriented, early intervention program that aims to promote positive, caring relationships between parents and their children and to help parents develop effective management strategies for a variety of common behavioural and developmental issues. This primary care intervention was trialled and disseminated in the current research. Study 1 examined the effectiveness of Primary Care Triple P implemented by child health nurses with clients requesting help for child behaviour problems. A randomised group methodology was employed, comparing the intervention with a waitlist control condition. Assessments were completed at pre, post and 6-month follow-up. Data are presented for 26 families. In comparison to the waitlist condition, families receiving the intervention showed a significant reduction in targeted child behaviour problem/s according to monitoring and mother-report. Mothers receiving the intervention also reported significantly reduced dysfunctional parenting practices, greater satisfaction with their parenting role, and decreased anxiety and stress following the intervention in comparison to waitlist mothers. No group differences were found for observed parent-child interaction. However, rates of observed disruptive child behaviour and aversive parent behaviour were low from the outset. Consumer satisfaction with the program was high, and intervention gains were primarily maintained at 6-month follow-up. These results provide some of the first effectiveness outcomes from a randomised controlled trial of BFI in a primary care setting, and establish the effectiveness and acceptability of Primary Care Triple P conducted by child health nurses as part of usual practice. Study 2 examined the implementation of Primary Care Triple P following professional training in the program. Results of a survey of 1078 professionals are presented. A model of the personal, program, training and workplace factors influencing program implementation was tested. Structured equation modelling confirmed that practitioner self-efficacy mediated the relationship between program characteristics and program implementation. Prior professional experience and satisfaction with training did not predict self-efficacy or uptake. Workplace support was also directly associated with program implementation. These results advance our knowledge of the aids and obstacles faced by practitioners in implementing a new program in the workplace. This research provides important new knowledge in relation to improving early access to empirically-supported intervention services and has implications for the potential scope of service delivery in primary care settings. It also advances our understanding of the factors influencing a professional’s ability to implement a new intervention program following training. This information may inform the development of future dissemination efforts, allowing them to address necessary program, personal and workplace supports, and optimise program implementation following training.

This thesis presents a program of research evaluating the implementation of a primary care intervention program for disruptive child behaviour, and the process of dissemination of the intervention to primary care staff. The specific aims were to: 1) evaluate the effectiveness and acceptability of a brief, preventive behavioural family intervention (BFI) administered by primary care staff in improving parenting skills and confidence and reducing targeted child behaviour problems; 2) assess the process of disseminating the intervention to primary care professionals by evaluating aids and obstacles for program implementation in the workplace; and 3) provide recommendations for future dissemination of psychological interventions. Childhood disruptive behaviour problems are becoming increasingly prevalent and are associated with significant personal and societal costs. Much is now known about the development of such problems, including individual, family and social risk and protective factors. There is considerable evidence that BFI programs are effective in reducing child behaviour problems and the family risk factors associated with the development and maintenance of these problems. Unfortunately, many evaluated programs have not been disseminated effectively, and have primarily been provided to clinical or high-risk populations in efficacy trials. Primary care settings have been increasingly identified as ideal settings for detection and early intervention for child mental health problems. However, there is limited research in the area of primary care BFI. While dissemination of psychological innovation to psychologists has historically been poor, with little impact on the professional practices of practitioners in the field, documentation of dissemination of these interventions to non-psychologists is rare. Although dissemination and diffusion theory have expanded, there is little controlled research evaluating the necessary or optimal conditions for the adoption and ongoing implementation of evidence-based programs. To address the problem of poor dissemination and limited access to evidence-based parenting programs in the community, a multilevel parenting and family support initiative, the Triple P-Positive Parenting Program, has been developed at the University of Queensland. One level of this system, Primary Care Triple P, encompasses a preventively oriented, early intervention program that aims to promote positive, caring relationships between parents and their children and to help parents develop effective management strategies for a variety of common behavioural and developmental issues. This primary care intervention was trialled and disseminated in the current research. Study 1 examined the effectiveness of Primary Care Triple P implemented by child health nurses with clients requesting help for child behaviour problems. A randomised group methodology was employed, comparing the intervention with a waitlist control condition. Assessments were completed at pre, post and 6-month follow-up. Data are presented for 26 families. In comparison to the waitlist condition, families receiving the intervention showed a significant reduction in targeted child behaviour problem/s according to monitoring and mother-report. Mothers receiving the intervention also reported significantly reduced dysfunctional parenting practices, greater satisfaction with their parenting role, and decreased anxiety and stress following the intervention in comparison to waitlist mothers. No group differences were found for observed parent-child interaction. However, rates of observed disruptive child behaviour and aversive parent behaviour were low from the outset. Consumer satisfaction with the program was high, and intervention gains were primarily maintained at 6-month follow-up. These results provide some of the first effectiveness outcomes from a randomised controlled trial of BFI in a primary care setting, and establish the effectiveness and acceptability of Primary Care Triple P conducted by child health nurses as part of usual practice. Study 2 examined the implementation of Primary Care Triple P following professional training in the program. Results of a survey of 1078 professionals are presented. A model of the personal, program, training and workplace factors influencing program implementation was tested. Structured equation modelling confirmed that practitioner self-efficacy mediated the relationship between program characteristics and program implementation. Prior professional experience and satisfaction with training did not predict self-efficacy or uptake. Workplace support was also directly associated with program implementation. These results advance our knowledge of the aids and obstacles faced by practitioners in implementing a new program in the workplace. This research provides important new knowledge in relation to improving early access to empirically-supported intervention services and has implications for the potential scope of service delivery in primary care settings. It also advances our understanding of the factors influencing a professional’s ability to implement a new intervention program following training. This information may inform the development of future dissemination efforts, allowing them to address necessary program, personal and workplace supports, and optimise program implementation following training.