Parent Training Programs for Parents of Teenagers

Adolescence is a period of enormous adjustment for both teenagers and families. As children transition from childhood to adulthood, they go through many physical, emotional and behavioural changes. Not surprisingly, many parents describe adolescence as the most difficult and anxiety-provoking period of their children’s life. Parents’ concerns are well justified, considering the high prevalence of emotional and behavioural problems during adolescence. Although health professionals and researchers share parents’ view of adolescence as a challenging period of life, the scope of research on adolescents is scarce compared to research on children and adults. However, this is now changing. Research on adolescent development and adolescent psychopathology has increased dramatically during the last two decades. Reducing risk factors in adolescents’ development has been receiving more and more attention both from researchers and policy makers. Family risk factors such as inadequate parental monitoring and family conflict are among potentially modifiable risk factors that can be targeted in order to reduce the rate of emotional and behavioural problems in adolescents. Behavioural family intervention is considered to be one of the promising intervention systems in this area because of the extensive empirical support it has received in research with families of preadolescence children. The research presented in this thesis focuses on parenting programs for parents of teenagers. The first study evaluates the efficacy of a behavioural family intervention (Triple P – Positive Parenting Program) targeting parents of teenagers. The second study explores factors which affect parents’ decisions to participate in parenting programs. The first study outlines a randomised control trial (RCT), assessing the efficacy of a parenting intervention in reducing behavioural problems in adolescents. The study provides support for an intensive individual version of Teen Triple P – a behavioural family intervention designed specifically for parents of high risk adolescents. The intervention aims to improve adolescent behaviour by reducing parents’ use of ineffective parenting. Participants were 46 families with a teenager aged 11 to 16. The outcomes of the intervention included a reduction in teen disruptive behaviours (d > .85) and parent-adolescent conflict (d = .1.21), as well as decreased parental use of harsh and coercive parenting strategies (d = 1.15) and a decrease in parents’ conflict over child rearing issues (d = .64). These positive changes were maintained at the three-month follow up. In spite of the growing recognition of parents’ need for information, guidance and support during the crucial and challenging years of adolescence, little is known about the factors which affect parents’ engagement in programs designed to help them in their parenting roles. The second study aimed to provide a conceptual framework for understanding parents’ decisions to accept or decline participation in a parenting program by employing the Health Belief Model (HBM). The model suggested that parents are more likely to participate in a program when they (a) perceive their adolescents to be susceptible to development of problem behaviours, (b) perceive the problem behaviours to have serious consequences, (c) believe the parenting program to be beneficial in reducing the risk of development of problem behaviours in their adolescent, (d) perceive the personal, social and financial cost of attending the program to be low, and (e) are confident in their ability to successfully learn and apply what they learn in these programs. The model explained 31% of the variance in parents’ inclination to participate in parenting programs. The study also showed that parents differ in their preferences of delivery format for parenting programs. These two studies contribute to the literature in a number of ways. Firstly, they demonstrate that parent training is an effective intervention in the treatment of adolescent problem behaviours. Secondly, they highlight the importance of addressing parents’ beliefs and attitudes about the benefits of parenting programs as well as reducing participation barriers to encourage greater parental engagement in prevention and intervention programs. Finally, the research emphasises that in order to increase participation rate, parenting programs should be made available in a range of delivery formats. The implications of the current research and future directions are presented and discussed

Using the Health Belief Model to Explain Mothers’ and Fathers’ Intention to Participate in Universal Parenting Programs

Using the Health Belief Model (HBM) as a theoretical framework, we studied factors related to parental intention to participate in parenting programs and examined the moderating effects of parent gender on these factors. Participants were a community sample of 290 mothers and 290 fathers of 5- to 10-year-old children. Parents completed a set of questionnaires assessing child emotional and behavioral difficulties and the HBM constructs concerning perceived program benefits and barriers, perceived child problem susceptibility and severity, and perceived self-efficacy. The hypothesized model was evaluated using structural equation modeling. The results showed that, for both mothers and fathers, perceived program benefits were associated with higher intention to participate in parenting programs. In addition, higher intention to participate was associated with lower perceived barriers only in the sample of mothers and with higher perceived self-efficacy only in the sample of fathers. No significant relations were found between intention to participate and perceived child problem susceptibility and severity. Mediation analyses indicated that, for both mothers and fathers, child emotional and behavioral problems had an indirect effect on parents’ intention to participate by increasing the level of perceived benefits of the program. As a whole, the proposed model explained about 45 % of the variance in parental intention to participate. The current study suggests that mothers and fathers may be motivated by different factors when making their decision to participate in a parenting program. This finding can inform future parent engagement strategies intended to increase both mothers’ and fathers’ participation rates in parenting programs

An efficacy trial: positive parenting program for parents of teenagers

Studies on the efficacy of parent training programs have mostly been conducted with preadolescents, with only a few studies investigating family treatment models in adolescents. In this article, a study is described that evaluates Standard Teen Triple P (Positive Parenting Program), a behavioural family intervention for parents of 11- to 16-year-old teenagers. Participants were 46 families with a teenager who was experiencing detectable behavioural and emotional problems. Compared to parents in the waitlist control condition, parents participating in the intervention condition reported decreased levels of teen disruptive behaviours and parent adolescent conflict, as well as a reduction in the use of ineffective parenting strategies and conflict over child-rearing issues. These positive changes were maintained at the 3-month follow-up. Results suggest that Standard Teen Triple P is a promising parenting intervention for tackling adolescent externalising problems

Attachment and trauma-informed programme to support forcibly displaced parents of youth in Sweden: feasibility and preliminary outcomes of the eConnect Online programme

Objectives To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents.Design The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments.Setting Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden.Participants Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8–17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect).Intervention eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions.Primary and secondary outcome measures Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent–child attachment insecurity.Results The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η2=0.29) and family functioning significantly improved (η2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η2=0.16).Conclusions The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment

The computer-assisted interview In My Shoes can benefit shy preschool children's communication

Interviewing children is a cognitively, socially, and emotionally challenging situation, especially for young and shy children. Thus, finding methods that aid rapport and increase these children's communication is important. The present study investigated whether children's verbal and non-verbal communicative behavior developed differently during the rapport phase, depending on whether children were situationally shy or not, and whether the interview was conducted using the computer-assisted interview In My Shoes (IMS) or a Standard verbal interview. The sample consisted of 60 children aged 4 to 5-years-old. The results showed that for the shy children in the IMS group their talkativeness increased and their answer latency decreased including the amount of encouragement the child needed to talk, while no changes were observed for the shy children in the Standard verbal interview group. There were no significant differences in the non-verbal behavior for the shy children regardless of the interview method used. For the non-shy children, overall, the interview method did not affect either the verbal or the non-verbal outcomes. Our findings indicate that IMS can be a useful tool during the rapport-building phase with shy children as it helps these children to improve their verbal communication

Facilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics : a mixed-methods process evaluation

Background: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. Methods: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Results: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. Conclusion: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families

SDQ in the Hands of Fathers and Preschool Teachers : Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds

The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives

Facilitating implementation of an evidence-based method to assess the mental health of 3-5-year-old children at Child Health Clinics: A mixed-methods process evaluation.

BackgroundA number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed.MethodsThe mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis.ResultsFacilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period.ConclusionThe facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families