Randomised Controlled Trial of Triple P intervention for multi-problem families

Behavioural and emotional problems are quite common in children and young
people. This is around one in five pupils in primary and secondary school who
has externalising problems and internalising problems. In Australia a
muti-discipline program has been developed for children and youngsters with
behaviour problems or emotional problems. The Triple P-Positive Parenting
Program consists of five levels, ranging from brief and broad support to
parents in dealing with a child who exhibits behavioural problems to an
intensive family intervention (level 4/5).

Hypotheses are: The Triple P intervention is similar or superior to the
Intensive Family Support in the comparing group in terms of clinical outcomes
(decrease of behavioural and emotional problems in children, improvement of the
parenting skills of parents, and decrease of the psychological complaints of
parents). The hypotheses will be tested two-site.

The objectives of this research is to asess the family-intervention Triple P on:
1) effectiveness in terms of (-) decrease of behavioural- and emotionel
problems of the child (SDQ)
2) effectiveness in terms of (-) improvement of the competence of the parents
in parenting (PS, PPC)
3) the effectiveness in terms of (-) decrease of the psychological complaints
of the parents (RQI en DASS).

We conduct a randomised controlled trial with two parallel groups: the
experimental conditition (family intervention of Triple P) and a 'care as
usual' control group. It is a pragmatic, non-blinded, multi-site trial.

In the experimental condition the family-intervention Triple P will be offered.
This is an indicated intervention for parents of children (4-13 years) with
concurrent child behaviour problems and family dysfunction such as parental
depression or stress or conflict between partners.

If during the Triple P intervention turns out that next to or after the Triple
P family intervention other support is necessary, the Triple P intervention can
be completed with other support (e.g. finding accomodation). This other support
will be registrated by the therapist.

The 'care as usual' control group is the Intensive Ambulant Family
intervention.'
This is different in each institute. The therapist will registrate what kind of
support the families have had. It is not necessarily to standard this 'care as
usual' in advance, because otherwise there will be a risk that the intervention
will be adapted and no good comparison can be made with the 'care as usual'.
It is essential for the research to assess the effects of the Triple P
intervention by comparison with the present (and variable) therapy for
multi-problem families.

In the experimental condition the family-intervention Triple P will be offered.
This is an indicated intervention for parents of children (4-13 years) with
concurrent child behaviour problems and family dysfunction such as parental
depression or stress or conflict between partners.
This family intervention exists of several modules:
• The individual parenting support Triple aimed on severe behavioural problems
in the child and dysfunction in the family. This module consists on 8-10
sessions (1 60- 90 minutes each) and 3 telephone sessions.
• Three modules for families with relational problems, psychological problems
in one of the parents, stress. Parents can follow one of those modules or all
three if they want. Each module consists of a maximum of three sessions of
60-90 minutes.

We expect no risks for the respondents, because:
- the respondents volunteer for support because of the problems with parenting
or dysfuntion in the family (psychological problems, relational problems,
stress). They will not be confrontated with new problems.
- the intervention is tailored to the requirements of parents and children.
Self regulation is a central skill. This involvs teaching parents skills that
enable them to become indenpendent problem solvers. The program 'empowers' and
not medicalizes.

The burden of participating is:
one introduction session (1 hour) + 8-10 sessions (1- 1 1/2 hour) + choice of 3
modules (1 - 1 1/2 hour) + homework (2 hours a week).
Total burden is between 40 and 100 hours, dependent on the choice of the extra
modules, including 2 hours to fill in the questionnairs (3 moments of
assessment).
The period of the intervention and research is 1 year (follow-up assessment 1
year after baseline-assessment)