Self-Help Triple P in the Netherlands: translation, adaptation, and evaluation

Because parents are so vital to children*s development within the family, there
is increasing emphasis
today on providing support, guidance and treatment services to adults who face
parenting problems.
Although some services are now available to parents in the Netherlands, very
few evidence-based
parenting support programmes to treat behavioural and emotional problems have
been validated for the
Dutch situation. There is a pressing need for such programmes.
Between 2003 and 2006, the Triple P parenting support programme was partially
implemented in
the Netherlands. Our research group is now introducing Triple P in its
entirety, translating and adapting it
and testing its effectiveness. The Triple P programme distinguishes five levels
of support, designed to
address the differing needs that families have. Together these form a
comprehensive system of
interventions that provide parents with the information and support they need
in bringing up their
children.
Although Self-Help Triple P (the level-4 self-administered variant for parents
of children with severe
behavioural problems) has not yet been implemented in the Netherlands, a recent
meta-analysis has
found that it has strong positive effects both on children*s behavioural
problems and on the parenting
skills, self-confidence and satisfaction of their parents (Speetjens and de
Graaf, in prep.).
The aim of the project is to translate Self-Help Triple P, adapt it to the
Dutch situation, and test its
effectiveness in a randomised controlled non-inferiority trial, in order to
ultimately improve its
implementation and resource materials in the Netherlands. The total duration of
this project will be 42
months.

The project*s aim is to translate Self-Help Triple P, adapt it to the Dutch
situation, and test its
effectiveness in a randomised controlled non-inferiority trial, in order to
ultimately improve its
implementation and resource materials in the Netherlands.

The research questions are as follow:
1. Are the effects of Self-Help Triple P comparable to the clinician-guided
Triple P intervention in terms of:
- child problem behaviour
- parenting skills
- psychological problems of the parents
2. Can we identify subgroups that derive particular benefit from the
intervention, such as groups defined
by sociodemographic characteristics, by child behaviour or by parenting style?
This could help to further
refine the self-help intervention, the resource materials, and the assessment
of client problems and
needs.
3. Does the intervention satisfy clients* (parents*) expectations?
4. What obstacles are encountered by practitioners in implementing the
intervention?

DESIGN: This study will be conducted as a randomised controlled non-inferiority
(equivalence) trial in
two parallel groups. Each will receive an active level-4 intervention: 1) the
Triple P self-help intervention;
or 2) a Triple P clinician-guided intervention (face-to-face or group Triple
P). Assessments will be made
at baseline (t0) and after 4 and 12 months (t1 and t2).

RANDOMISATIE. Stratified randomization in 2 referral streams: (1) Parents who
apply for child intervention services (geïndiceerde jeugdzorg) via Bureau
Jeugdzorg (Youth Care Office) and (2) Parents who apply for child intervention
services via the prevention departments of the participating mental health
services (GGZ/preventie). This is necessary since we expect differences in
child behavioral problems in both types of services. We will randomise the
parents to self-help or guided interventions in blocks of approximately four
parents.

CONDITION 1: THE CLINICIAN-GUIDED TRIPLE P INTERVENTION LEVEL 4
In this condition the guided Triple P intervention (level 4) is offered (both
individual and group intervention). The level 4 Triple P intervention is a
indicated intervention for parents of children with (serious) persisting
behavioral problems. The intervention consists of 10 sessions of approximately
90 minutes, including telephonic sessions.

CONDITIE 2: DE ZELFHULPINTERVENTIE TRIPLE P NIVEAU 4
In this condition the self-help Triple P intervention (level 4) is offered.
Again, the intervention is a indicated intervention for parents of children
with (serious) persisting behavioral problems. The intervention consists of 10
self-help sessions of approximately 90 minutes, supplemented by weekly
telephonic consults or e-mail contact.

END TERMS. The primary outcome measure will be changes in child behaviour. The
secondary outcome measure will be changes in parenting styles, self-confidence
and parental psychological problems.

MEASUREMENTS. Assessments will be made at baseline (t0) and after 4 and 12
months (t1 and t2).

REPORTING: Reports will conform to the adapted Consort checklist, the
recognised international
guidelines for reporting non-inferiority and equivalence trials (Piaggio et
al., 2006).

TIME LINE: The trial will proceed in the following steps: (A) Preparatory stage
(9 months): translating the
parents* workbook, training the practitioners, recruitment of parents by the
agencies. (B) Research stage
(30 months): In an 18-month period, the self-help and guided interventions will
be administered by the
four participating agencies. Practitioners will first have 6 months to master
the intervention, after which
the baseline (T0) assessment will begin, and the T1 and T2 follow-up
assessments will take place at 4
and 12 months after baseline. (C) Evaluation and reporting stage (3 months).
The total duration will be
42 months.

BURDEN ASSOCIATED WITH THE STUDY.
Respondents in both conditions compete a questionnaire at three points in time:
preceding the intervention (t0), after 4 months (t1) and after 12 months (t2).
Competing each questionnaire will take up 30 - 45 minutes.

RISKS. We expect no risks for the participants because:
(-) participants apply voluntary to the intervention because they need help
with the behaviour of their child.
(-) the intervention concerns a parenting course, no therapy.
(-) in both groups, an active intervention is offered and the family is
assigned to a professional. In case of any unforseen crisis, the professional
can take action.