"Is Service Provider Perception of a Caregiver's Commitment to Triple P Related to Improved Child Behavior in Child-Welfare Involved Children?"

Background: The Triple P parenting program, an evidenced-based practice (EBP), has been found to enhance parenting competence, resulting in improvement in children’s behavioral problems (Sanders et al., 2014). There is evidence that it can be successful with child-welfare involved families (Petra & Kohl, 2010). Moreover, treatment outcomes associated with caregivers’ socio-demographic factors (Heinrichs et al., 2005) and service providers’ perceptions of caregivers’ commitment to the program (Hanna & Rodger, 2002) have been observed.This study aimed to explore whether parent factors (socio-demographic characteristics) and therapist factors (therapists’ perceptions of caregivers’ commitment to Triple P) predict the number and the severity of children’s behavioral problems at the end of the treatment, after controlling for their behavioral problems at baseline.

Methods:Information was collected from 62 child-welfare involved families living in a rural area who were part of the Pennsylvania Title IV-E waiver demonstration project. The Eyberg Child Behavior Inventory (ECBI; Eyberg, 1999) assessed whether the caregivers perceived their child’s behavior as a problem (problem score) and how severe the behavioral problems are (intensity score). At the end of the treatment, service providers completed a summary form which includes a question about how committed they perceived the caregiver to be to the treatment, and the caregivers completed the ECBI. Bivariate and hierarchical regression analyses were performed to identify whether the parent predictors and therapists’ perceptions of commitment would explain improvement in the number and the severity of the behavioral problems.

Results: The majority of caregivers were whites (96.72%). 32.8% of the caregivers were never married; 23% were separated, divorced, or widowed; 26.2% were married; the remaining 18% were living with someone. 78% earned a high school diploma or less; 11.9% had post-secondary education. All hierarchical regression models predicting each ECBI’s problem-and intensity scores were significant. In the final regression models, the predictors accounted for almost 62.5% of the variances in the ECBI’s problem scores, (F(7,39)=9.27, p=.000) and 56.9% of the intensity scores (F(7,39)=7.37, p=.000). Therapists’ perceptions of the caregivers’ commitment to the treatment predicted lower levels of problem scores (b=-2.68, p=.031) and intensity scores (b=-3.45, p=.014). Separated, divorced, or widowed caregivers showed higher levels of the severity compared to married caregivers, while education level and the baseline scores were controlled for (b=7.53, p=.085). Yet marital status was not predictive for ECBI’s intensity scores, after controlling for commitment, suggesting mitigating effects of therapists’ perceptions of commitment on the problems.

Conclusions: Separated, divorced, or widowed caregivers were found to perceive behavioral problem as more severe, which might be due, in part, to the family separation or lack of partner support. However,the more engaged the families are in Triple P (as perceived by the therapist view of commitment), the more that caregivers and children may benefit from services. Although it could not be determined from this study, therapists’ perception of higher levels of caregivers’ commitment might lead to positive treatment outcomes (Shapiro, Prinz, & Sanders, 2011). Additional studies investigating the effects of therapists’ perceptions of parent engagement on the treatment outcomes are needed.