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 professionals 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.
| Identifer | oai:union.ndltd.org:ADTP/290343 |
| Creators | Turner, Karen Mary Thomas |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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