Process evaluation of a parenting intervention for pre-schoolers with intellectual disabilities who display behaviours that challenge in the UK.

BACKGROUND: Stepping Stones Triple P (SSTP) is a complex parent-mediated intervention aimed to reduce behaviours that challenge in children with moderate to severe intellectual disabilities, aged 30-59 months. METHODS: To formulate a comprehensive understanding of SSTP implementation in the UK, we conducted a process evaluation collecting stakeholder views and considering intervention fidelity, dose, reach, delivery adaptations, and acceptability. RESULTS: Fidelity and quality of delivery ratings were high. Parents perceived SSTP as valuable, reporting increased parental confidence and understanding of the child's behaviours. However, only 30% of families received an adequate dose of the intervention. Parents who only received treatment as usual described feeling abandoned by current services. Service managers emphasised the importance of availability of resources and therapist training for successful intervention delivery. CONCLUSIONS: SSTP supports effective management of early-onset behaviours that challenge. Further work is needed to ensure equitable access to the intervention across health and social care services. TRIAL REGISTRATION: NCT03086876 - https://www. CLINICALTRIALS: gov/ct2/show/NCT03086876?term=Hassiotis+Angela&draw=1&rank=1.

The effectiveness of the Stepping Stones Triple P seminars for Korean families of a child with a developmental disability.

Background: Children with a developmental disability (DD) are more likely to develop behavioral problems. The Stepping Stones Triple P Positive Parenting Program (SSTP) for parents of children with a DD has demonstrated effectiveness for improving parenting practices and reducing child behavior problems. However, there is scant research in Asian countries and with less intensive SSTP interventions. Aim: This study examined the effectiveness of the SSTP seminars for Korean parents of a child with a DD. Methods: Parents were randomly assigned to an intervention group (n = 21) or a delayed intervention group (n = 17). Data was collected on child adjustment problems, parenting practices, parental adjustment, and family relationships from both groups at pre- and post-intervention, and from the intervention group at 4-month follow-up. Twelve parents provided post-intervention interview data. Results: A series of one-way Analysis of Covariance (ANCOVA) were used to examine differences between the intervention and delayed intervention groups at post-intervention. Significant short-term intervention effects were found for reductions in child behavior and emotional difficulties, and dysfunctional parenting practices. These improvements were maintained 4-months later by the intervention group. At post-intervention, inter-parental child-rearing conflict was reduced as a trend, with a moderate effect size. Interviews provided additional insights into the benefits gained from program participation. Conclusions: Findings, for parents within this study, contribute to the evidence base for the effectiveness of the SSTP seminars.

Clinical and cost effectiveness of a parent mediated intervention to reduce challenging behaviour in pre-schoolers with moderate to severe intellectual disability (EPICC-ID) study protocol: a multi-centre, parallel-group randomised controlled trial.

BACKGROUND: Children with intellectual disabilities are likely to present with challenging behaviour. Parent mediated interventions have shown utility in influencing child behaviour, although there is a paucity of UK research into challenging behaviour interventions in this population. NICE guidelines favour Stepping Stones Triple P (SSTP) as a challenging behaviour intervention and this trial aims to evaluate its clinical and cost effectiveness in preschool children with moderate to severe intellectual disabilities. METHODS: This trial launched in 2017 at four sites across England, with the aim of recruiting 258 participants (aged 30-59 months). The Intervention Group receive nine weeks of SSTP parenting therapy (six group sessions and three individualised face to face or telephone sessions) in addition to Treatment as Usual, whilst the Treatment as Usual only group receive other available services in each location. Both study groups undergo the study measurements at baseline and at four and twelve months. Outcome measures include parent reports and structured observations of behaviour. Service use and health related quality of life data will also be collected to carry out a cost effectiveness and utility evaluation. DISCUSSION: Findings from this study will inform policy regarding interventions for challenging behaviour in young children with moderate to severe intellectual disabilities. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, NCT03086876. Registered 22nd March 2017, https://clinicaltrials.gov/ct2/show/NCT03086876.

Effectiveness of the Stepping Stones Triple P group parenting program in reducing comorbid behavioral problems in children with autism.

Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families' quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents' and teachers' judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents' judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers' judgment particularly revealed an improvement in children's social relationships. Effect sizes were large (ƞ2 ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents' ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.

Effectiveness of the Stepping Stones Triple P Group Parenting Program as an Additional Intervention in the Treatment of Autism Spectrum Disorders: Effects on Parenting Variables.

Parents of children with autism spectrum disorders (ASD) often are faced with the challenges of difficult parenting situations. We explored the effectiveness of the Stepping Stones Triple P (SSTP) group parent training as an additional intervention in the treatment of ASD. Parents (n = 23) went through a waiting period and participated afterwards in the training program. We assessed parenting variables via self-report measures. After the intervention, there was a significant reduction of over-reactive parenting behaviors, role restriction and an increase in parental self-efficacy. At follow-up, the effects remained stable and we additionally found a reduction of laxness and less parenting stress. Effect sizes were high (η2: 0.18-0.24). The SSTP, offered as an additional intervention in the treatment of ASD, proved to be effective in enhancing parenting.

Improving child and parenting outcomes following paediatric acquired brain injury: a randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy.

BACKGROUND: Persistent behavioural difficulties are common following paediatric acquired brain injury (ABI). Parents and families also experience heightened stress, psychological symptoms and burden, and there is evidence of a reciprocal relationship between parent and child functioning, which may be mediated by the adoption of maladaptive parenting practices. Despite this, there is currently a paucity of research in family interventions in this population. The aim of this study was to determine the efficacy of Stepping Stones Triple P: Positive Parenting Program (SSTP), with an Acceptance and Commitment Therapy (ACT) workshop, in improving child outcomes and parenting practices following paediatric ABI. METHODS: Fifty-nine parents of children (mean age 7 years, SD 3 years, 1 month; 35 males, 24 females) with ABI (Traumatic injuries 58%, Tumour 17%, Encephalitis or meningitis 15%, Cardiovascular accident 7%, Hypoxia 3%) who were evidencing at least mild behaviour problems were randomly assigned to treatment or care-as-usual conditions over 10 weeks. Mixed-model repeated-measures linear regression analyses were conducted to compare conditions from pre- to postintervention on child behavioural and emotional functioning (Eyberg Child Behavior Inventory, Strengths and Difficulties Questionnaire) and dysfunctional parenting style (Parenting Scale). Assessment of maintenance of change was conducted at a 6-month follow-up. The trial was registered on Australian New Zealand Clinical Trials Registry (ID: ACTRN12610001051033, www.anzctr.org.au). RESULTS: Significant time-by-condition interactions were identified on number and intensity of child behaviour problems, child emotional symptoms and parenting laxness and overreactivity, indicating significant improvements in the treatment condition, with medium-to-large effect sizes. Most improvements were maintained at 6 months. CONCLUSIONS: Group parenting interventions incorporating Triple P and ACT may be efficacious in improving child and parenting outcomes following paediatric ABI.

A randomized controlled trial of group Stepping Stones Triple P: a mixed-disability trial.

Stepping Stones Triple P (SSTP) is a parenting program designed for families of a child with a disability. The current study involved a randomized controlled trial of Group Stepping Stones Triple P (GSSTP) for a mixed-disability group. Participants were 52 families of children diagnosed with an Autism Spectrum Disorder, Down syndrome, Cerebral Palsy, or an intellectual disability. The results demonstrated significant improvements in parent-reported child behavior, parenting styles, parental satisfaction, and conflict about parenting. Results among participants were similar despite children's differing impairments. The intervention effect was maintained at 6-month follow-up. The results indicate that GSSTP is a promising intervention for a mixed-disability group. Limitations of the study, along with areas for future research, are also discussed.

Experience and outcomes of stepping stones triple P for families of children with autism.

This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the "attribution of cause" of misbehaviour, (2) "Who's the boss?" reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) "Rewarding is rewarding!" reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.

Home-based interventions for the children with mental retardation / 国际儿科学杂志

Home-based intervention is a essential for rehabilitation treatment for the children with mental retardation.This paper describes the methods of home-based intervention for children with mental retardation,which include Portage Project,parent-child interaction therapy,snoezelen therapy and Stepping Stones Triple P and reviews their current situations and curative effect in order to provide a reference for the application of these methods in China in the future.Each method has its own principle and advantages,and meanwhile it plays an active role in reducing disruptive behavior of children with mental retardation and optimizing parenting styles of parents.