Child Welfare Involved Parents and Pathways Triple P: Perceptions of Effectiveness, Acceptability and Appropriateness

Purpose:  Nearly half of children in the child welfare system have clinically significant behavior problems and are at risk of developing conduct disorder. Yet, behavioral parent training interventions, which are the most effective way to treat these problems, are typically not provided to child welfare involved families. Further, the vast majority of the evidence establishing the effectiveness of parenting interventions has been with families in the general population. As we translate evidence-based parenting interventions, such as Pathways Triple P, to this new population and new service sector, it is essential to determine both its effectiveness and its fit.  This qualitative study provides an initial step in filling this gap. The specific aims were to assess parents’ perceptions of: (1) improvements in their parenting behavior and their child’s behavior, and (2) implementation outcomes of acceptability (that the service is satisfactory or agreeable), and appropriateness (perceived fit for a setting) of Pathways Triple P with a child welfare population.

Method: Parents investigated for child maltreatment (n=21) who received Pathways Triple P, as part of a larger RCT comparing Pathways to treatment-as-usual, participated in a semi-structured interview following participation in the intervention.  All parents had a child between 3 and 11 years old who remained in-home following the maltreatment investigation.  The study was conducted in a mid-western urban area.  About half of the parents in the sample were African American (52%), and 52% had a high school diploma or GED. The mean age was 32.6 years.  The interview guide sought to ascertain parents’ perceptions of skill gain, changes in their child’s behavior and acceptability and appropriateness for treatment completers (n=14) and non-completers (n=7).  Qualitative data analysis of transcribed interviews was conducted using NVivo.

Results:  Almost all parents said they learned useful parenting skills through their participation in Pathways Triple P.  Many parents identified changes in their attitude toward parenting and in their parenting behaviors.  They further attributed change in their behavior to improvements in their child’s behavior, e.g. being consistent with using timeout resulted in their child following directions.  Completers tended to report learning and using more new parenting skills.  They also described enjoying their relationship with the Pathways Triple-P practitioner and appreciated that the intervention was delivered in their home.  Non-completers reported difficulty scheduling the sessions because of the complications in their lives, such as visiting children in different placements or returning to school.   However, despite not completing the whole intervention many reported learning some skills from the sessions completed and thought it was a good program.

Implications:  These findings suggest that child welfare involved parents perceive the intervention as effective, acceptable and appropriate. Even parents who did not receive the full dosage of the intervention saw benefits. Further evaluation of the effectiveness of Pathways with child welfare involved families is warranted but these favorable implementation outcomes indicate its appropriateness in child welfare settings.  Despite the complicated and often chaotic lives common among this vulnerable population, Pathways Triple P holds promise as a strategy to improve behavioral health outcomes of maltreated children.