Parenting and Child Behavior Outcomes 18 Months Following Participation in Pathways Triple P: Are Gains Sustained Among Child Welfare Involved Families?

Background and Purpose: Studies have shown that parents with a history of maltreatment tend to exhibit more maladaptive caretaking practices and have less frequent parent-child interactions than parents without such a history. Further, their children often develop behavioral disorders. Although behavioral parent training (BPT) has been widely recognized as an effective strategy for addressing disruptive child behaviors, limited research has examined the effectiveness of BPT on child welfare (CW) involved families. To address this gap, this randomized controlled trial assessed the effectiveness of the Pathways Triple P, a parent management training program developed for families at risk of child maltreatment, on parenting and child disruptive behaviors among a CW-involved population.

Methods: The study included 144 parent-child dyads whose children remained at home after a maltreatment investigation. Structured interviews were conducted at four intervals: baseline, four months after baseline, nine months after baseline, and 18 months after baseline. This study focused on the maintenance of intervention effectiveness. Therefore, multi-level modeling with difference-in-differences methods was used to assess the impact of treatment 18 months after baseline using data of all four-time points. Measures of interest included the Parental Sense of Competence (PSC), Eyberg Child Behavior Inventory (ECBI), Parental Anger Inventory (PAI), Parenting Stress Index (PSI), and Pediatric Quality of Life (PQL). Because prior studies have shown larger effects for Triple P among children with more severe problems at baseline, we also conducted subgroup analysis considering children above and below the clinical threshold for child behavior problems.

Results: The study randomly assigned participants to either the Pathways Triple P condition (n = 75) or a comparison condition (n = 69). Two-thirds (68%) of the caregivers self-identified as African Americans or biracial, while 32% self-identified as White. Females made up the majority of caregivers (93%), and most were married or living with a significant other (68%) with a high school education or lower (57%). Most families were economically disadvantaged, with 90% qualifying for free or reduced lunch. Almost 58% of the children were male, and the mean child age was 7.39 years (SD=2.00). At 18 months after baseline, parents in the treatment group reported higher parental self-efficacy on the PSC (b=.19, p<.001) than those in the control group. However, no significant findings were found for the ECBI, PSI, PAI, and PQL. Subgroup analysis revealed that for children above the ECBI clinical threshold at baseline, the intervention enhanced parental self-efficacy (b=.24, p<.01), consistent with the findings from the entire sample. Meanwhile, for children below the ECBI clinical threshold, the intervention not only increased parental self-efficacy (b=.14, p<.05) but also significantly reduced disruptive child behavior (b=-.73, p<.05).

Conclusions and implications: This study suggests that CW-involved parents who participated in Pathways Triple P experienced sustained improvements in parental self-efficacy at 18-months. Contrary to the findings of others, among CW-involved families who likely have more complex challenges compared to non-CW-involved families, Pathways was more effective with children with less severe behavior problems. Pathways Triple P holds promise as an effective intervention with some, but not all, CW-involved families.