Pathways Triple P with Parents Referred to Child Protective Services:
Will Implementation with this High Need Population Work?
Principal Investigator: Patricia Kohl, PhD, PI
Funder: National Institute of Mental Health
Timeframe: 03/08-10/08
Affiliation: Center for Mental Health Services Research (CMHSR)
Project Staff: Samantha Books
Megan Petra
Gayle Ervin
Teshaba Wadley
Almetra Johnson
Lora Gulley
Ragini Maddipati
Project Contact: Samantha Books
(314) 935-9545
Project Update as of 09/23/2009
Stage: Completed
Description:
Children victimized by child abuse and neglect (henceforth referred to as child maltreatment) often experience serious and costly mental health problems. There is a critical need to demonstrate the transportability of cost-effective, evidence-based interventions from traditional mental health service delivery settings to the child welfare system to target this particularly vulnerable population and reduce their risk for adverse distal outcomes. The child welfare system is in critical need of cost-effective, efficacious interventions to improve the mental health outcomes of maltreated children. The Positive Parenting Program (Triple P), a multi-layer behavioral family intervention, holds promise as an effective intervention with this population in that it has been shown to reduce child behavior problems and parental stress among a variety of parent populations, including parents of children with early onset conduct disorder, parents at risk of child maltreatment, depressed mothers, and parents experiencing marital conflict (Sanders et al., 2003; Sanders, Markie-Dadds, Tully & Bor, 2000; Sanders & McFarland, 2000). Furthermore, add-on modules (Pathways) have been developed to target the additional needs of parents at high risk of maltreatment (Sanders, Pidgeon, Gravestock, Conners, Brown & Young, 2004).
This program of research seeks to explore the feasibility of implementing Triple P with foster parents and Pathways Triple P with parents who have been referred to the Child Protective Services “hotline” due to child abuse or neglect.
Although Pathways Triple P has limited empirical evidence and Triple P has never been tested with parents referred to CPS in the US, the populations for whom Triple P has been effective mirror this population in many ways. Before Pathways Triple P can be tested among parents referred to CPS in the U.S., certain questions must first be answered. This pilot study will provide preliminary data for a larger randomized clinical trial (RCT) testing the effectiveness of Pathways Triple P following a CPS referral. Specifically this pilot study will determine: (1) the feasibility of implementing Pathways Triple P with parents referred to CPS, (2) the feasibility of implementing Pathways Triple P within a child welfare system in the U.S., (3) the suitability of a battery of instruments to measure parenting practices, parenting-child relationship, parental stress and anger, child behavior problems and parental capacity to maltreat their child, (4) the sample size necessary to detect meaningful differences, and (5) the costs associated with implementing the Pathways Triple P with this populations in this setting.
The overarching objective of this pilot is to develop and refine the research protocol for a larger study of Pathways Triple P. The specific aims of this project are to:
1. Determine the feasibility of implementing Pathways Triple P within one U.S. child welfare system with parents who have been referred to CPS.
a. Assess and refine recruitment and retention strategies.
b. Assess ability to simultaneously recruit and provide treatment to parents receiving case management services through the public child welfare agencies and parents receiving case management services through the private performance based contract agencies.
c. Assess appropriateness of combining parents whose child remained in home with parents whose child has been reunified following a period in foster care.
d. Identify barriers and facilitators to parent participation in the group intervention and home-based portions of Pathways Triple P.
e. Explore reasons that parents drop out of the treatment group, or do not attend any of the intervention session, after initially consenting to participate.
f. Determine ability to follow-up with parents randomly assigned to the comparison group.
g. Determine costs associated with implementing the intervention.
2. Collect data to be used as preliminary data for a larger RCT that will test both proximal and distal outcomes of Pathways Triple P implemented within a U.S.child welfare system with parents referred to CPS.
a. Collect pre- and post-intervention data from a battery of standardized instruments to determine parents’ willingness to complete the selected instruments, whether the instruments adequately capture outcome data of interest for the RCT and whether instruments should be added or deleted from the protocol.
b. Assess parents’ willingness to be videotaped for ten minutes while playing with their child and determine if videotaping protocol should be revised for RCT.
c. Examine short term outcomes by answering the following questions:
i. Do parents receiving Pathways Triple P demonstrate more positive parenting behaviors at post-test than at pre-test, as compared to parents not receiving Pathways Triple P?
ii. Do children of parents receiving Pathways Triple P exhibit fewer behavior problems at the conclusion of the intervention compared to at the start of the intervention?
d. Calculate effect sizes in order to determine sample size necessary to detect meaningful differences in larger study.
3. Develop and/or strengthen relationship with key stakeholders.
a. Convene an advisory board that will meet three times over the course of the pilot study. The purpose of the advisory board will be two-fold. First, the process will be used for network development, team building and to develop personal relationships between project staff, key stakeholders and community opinion leaders. Second, the process will also be used to obtain the perspectives and perceptions of the board members about the service needs of parents referred to CPS, the Pathways Triple P intervention, and feasibility of implementing Pathways Triple P within the Missouri child welfare system.