Waarom ouders deelnemen aan professionele opvoedingsondersteuning. Participatie van ouders in Triple P Tieners

Waarom ouders deelnemen aan professionele opvoedingsondersteuning. Participatie van ouders in Triple P TienersOpvoedprogramma’s worden steeds meer als interventie gebruikt ter ondersteuning van ouders die zorgen en vragen hebben over de ontwikkeling en het gedrag van hun kinderen. Terwijl veel studies zich richten op de effectiviteit van deze programma’s en onderzoek laat zien dat ouderlijke motivatie, betrokkenheid en participatie van invloed zijn op de effectiviteit, is er weinig bekend over waarom ouders zich aanmelden en deelnemen. Ook is er weinig bekend over programma’s voor ouders van tieners, terwijl hun opvoednood juist in deze periode groot is. Deze studie onderzoekt de vraag of de Groep Triple P Tieners toegankelijk is voor ouders van diverse achtergronden en wat hen motiveert tot deelname. De resultaten van 50 half-gestructureerde interviews met deelgenomen ouders laten zien dat ondanks verschillende redenen en manieren van aanmelding (op eigen initiatief of verwezen door een professional), ouders van diverse achtergronden de bijeenkomsten en de cursusleiding waarderen. Maar ook zijn ze het erover eens dat de groepssamenstelling onevenwichtig kan zijn vanwege verschil in leeftijd van tieners en zwaarte van de gedrags- en opvoedproblematiek die ouders inbrengen. De combinatie van ouders met algemene vragen over de puberteit én ouders met specifieke zorgen over het probleemgedrag van hun tiener kan de wederzijdse herkenning en groepsuitwisseling belemmeren. We concluderen dat ouders van verschillende achtergronden Groep Triple P Tieners waarderen, maar dat meer aandacht nodig is voor de werving, samenstelling en begeleiding van de groep om de toegankelijkheid en participatie te vergroten.  Why parents participate in professional parenting support programmes. Participation of parents in the “Triple P Teens” programmeParenting programmes are increasingly being used as an intervention to support parents who experience difficulties with or have questions about their children’s development and behaviour. These programmes are implemented in many different parts of the world through individual consultations and/or group training sessions. They provide parents with a range of techniques and exercises to improve their understanding and handling of their children’s behaviour. They are used in parenting situations which already are tense and conflictual, with the aim of preventing the escalation of problems in everyday parenting. While many studies have focused on the effectiveness of these programmes, and research shows that parental motivation, involvement and participation all influence this effectiveness, little is known about which parents enrol and participate, and why they do so. Groups of vulnerable parents (parents with lower levels of educational attainment and/or a from non-Western migrant background) are less inclined to turn to professional parenting programmes, even though their parenting insecurity is high, particularly among parents with teenagers. Moreover, little is known about programmes that focus on the parents of teenagers. This study examines the question of whether “Group Triple P Teens” is accessible for parents from diverse ethnic and social backgrounds and what encourages their participation. Triple P is a “Positive Parenting Program” developed in Australia, which has been implemented in more than 25 countries, including the Netherlands. It consists of a comprehensive, five-level system of interventions, ranging from collective prevention, individual parenting consultation and group training, up to more intensive guidance for the parents of children with severe behavioural problems. Group Triple P Teens level 4 is for parents of teenagers up to 16 years old with mild to moderate behavioural problems or who wish to prevent behavioural problems from developing. The programme involves four (two-hour) group sessions with up to 12 parents, three individual telephone sessions and one closing session. For our study, semi-structured interviews were held with 50 participating parents (37 mothers, 3 grandparents who raised their grandchildren, 10 fathers) from different social and ethnic backgrounds, and with different family situations (two-parent and single families), who are raising between 1 and 4 children. The ages of the teenagers vary between 10 and 17 years, with a mean age of 13.4 years, 50% boys and 50% girls. The subjects addressed in the interview were: how and why the parents had enrolled; their experience of participation (group, sessions, homework, location); their perceptions of the training staff (attitude, expertise). Our results show that most parents who sign up are already familiar with “Triple P” (have heard or read about it, or had participated previously) and/or have been referred to the programme by a professional (from school, their local neighbourhood, child welfare institution) who is familiar with the family. These parents (76% of the respondents, both those from a Dutch background and from various ethnic backgrounds) had been referred to the programme because they want to improve the atmosphere at home, cooperation with their (ex-)partner, or learn to handle specific teenage problems. Within this group, the teenagers of 15 parents were already receiving youth care because of learning and/or behavioural problems (PDD-NOS, ADHD, truancy, running away from home, conflicts with the law). A minority (24% of the interviewed group, mainly parents of a Dutch background) had joined the programme on their own initiative. Their reasons for enrolling and participating varied from “wish to learn about puberty” to “being desperate to know how to handle my teenager”. Despite the range of reasons for parents signing up (own initiative or referred by a professional), they shared a positive motivation to participate in the group sessions and saw the trainers in a positive light. Sharing experiences with other parents in the group was found to be the first and main reason for continuing to participate, with some respondents citing recognition of the problems of other parents and relief that “we are not the only ones”, or “I thought our situation was hell, but now I meet other parents in the same situation.” Roleplay exercises and watching and discussing videos can generate ideas and advice on how to change their parenting behaviour. The trainers were considered experienced and able to handle the group dynamics in a positive way, to pay attention to both the group and individual parents. However, some of the respondents agreed that the composition of the group was sometimes unbalanced with respect to the severity of the behavioural problems and parenting problems within the same group. Both parents with general questions about adolescence as well as parents with specific concerns about problem behaviour of their teenager pointed out that these differences can be an obstacle to mutual understanding and discussion. Parents of thirteen-year-old teenagers without “serious problems” sometimes wondered whether they were in the right group. The same question was asked by parents who were having to deal with older teenagers with more serious behavioural problems: “we are far beyond disagreements about doing the dishes, pocket money or gaming time.”  As for the accessibility of the programme for parents of different social and ethnic backgrounds, “Group Triple P Teens” appears not to be equally accessible for all. Mainly motivated parents from a Dutch background had joined the programme on their own initiative, and were able to overcome the obstacles to enrolment (finding the website, selecting a course, calling or mailing again if they did not receive an answer straight away). The majority of the parents had signed up after referral by a professional and were already familiar with the programme and trainer. As for participation after enrolment, factors such as the use of language in materials (these were all in Dutch), training sessions and discussions, and the speed of the programme (many topics covered, exercises and homework in a short space of time) could undermine the parents’ motivation to continue. As mentioned previously, the composition of the groups was sometimes unbalanced with respect to the severity of the behavioural and parenting problems experienced, and this could also limit the learning experience and the parents’ motivation to participate. One of the limitations of our study was that we only interviewed parents who had stayed in the programme. More insight into the reasons and circumstances for not enrolling, failing to show up or subsequently dropping out of “Group Triple P Teens” is necessary to give a more comprehensive and detailed picture of the accessibility of the programme for a broad and diverse group of parents who require support with raising their teens. We conclude that parents from different backgrounds value “Group Triple P Teens”, but that the enrolment process and the composition and coaching of the groups should be reviewed in order to enhance the accessibility of the programme and parental participation

School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial

Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). Methods: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. Results: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. Conclusions: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. Trial registration The study was registered as ISRCTN4228482

Waarom ouders deelnemen aan professionele opvoedingsondersteuning: Participatie van ouders in Triple P Tieners

Wetenschappelijk artikel over de toegankelijkheid van het opvoedprogramma Triple P Tieners en de motivatie van ouders om deel te nemen. De resultaten van 50 half-gestructureerde interviews laten zien dat ondanks verschillende redenen voor deelname en wijze van aanmelding, deelgenomen ouders de bijeenkomsten en de cursusleiding waarderen. Wel zijn ze kritisch over de groepssamenstelling. Die is vaak onevenwichtig door verschil in leeftijd van tieners en zwaarte van de gedrags- en opvoedproblematiek die ouders inbrengen

School-based mental health intervention for children in war-affected Burundi: A cluster randomized trial

Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). Methods: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. Results: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. Conclusions: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. Trial registration: The study was registered as ISRCTN42284825

Potential treatment mechanisms of counseling for children in Burundi:a series of n=1 studies

Little is known about the impact and treatment processes of psychosocial counseling in low-income countries. This study aimed to generate hypotheses on key working mechanisms of counseling in Burundi. The authors carried out 11 empirically grounded n = 1 studies with children (11-14 years) screened for depression and anxiety who received counseling. The authors used quantitative (symptom scales) and qualitative instruments (treatment content and perceptions). Weekly measurements were taken preintervention (4 time points), during the intervention period (8-10 time points), and postintervention (4 time points). Five treatment mechanisms continua appeared associated with outcome trajectories: client centeredness, therapeutic alliance, active problem solving, trauma-focused exposure, and family involvement. Higher levels appeared associated with better outcomes. Contrarily, cases that demonstrated no change were characterized by a heavy focus on counselors’ norms, containment and self-control, unstructured retelling and explicit avoidance, advice-oriented problem solving, and noninclusion of family members, respectively. The authors found a distinct clustering of outcome trends per therapist. The findings suggest that integrative counseling, which combines universal therapist variables with active use of specific therapeutic techniques and a systemic perspective, may be an adequate strategy to treat mental health symptoms of children in Burundi