Advertisement

Training Pediatric Residents to Provide Parent Education: A Randomized Controlled Trial

      Abstract

      Objective

      We evaluated the effect of Primary Care Positive Parenting Program (Triple P) training on pediatric residents and the families they serve to test 2 hypotheses: first, training would significantly improve resident skill in identifying and addressing discrete parenting and child behavior problems; and second, parents would report an improvement in their sense of self-efficacy, use of positive discipline strategies, and their child's behavior.

      Methods

      Study participants included pediatric residents from 3 community clinics of a pediatric residency program, as well as English-speaking parents of children aged 18 months to 12 years without a diagnosed behavior disorder cared for by study residents. Residents were randomized to receive Primary Care Triple P training either at the beginning or end of the study period. The measured resident outcomes were self-assessed confidence and skills in giving parenting advice. The measured family outcomes were parent sense of self-efficacy, child externalizing behavior, and discipline strategies.

      Results

      Primary Care Triple P training had a positive, significant, and persistent impact on residents' parenting consultation skills (mean increase on Parent Consultation Skills Checklist 48.11, 95% confidence interval [CI] 40.07, 57.36). Parents visiting intervention-trained residents demonstrated improved disciplinary practices compared to parents visiting control residents (mean change in Child Discipline Survey 0.322, 95% CI 0.02, 0.71), with stronger differential effects for parents with lower baseline skills (mean Child Discipline Survey change 0.822, 95% CI 0.48, 1.83). No differences were found for child behavior or parenting sense of confidence.

      Conclusions

      Training residents in Primary Care Triple P can have a positive impact on consultation skills and parent disciplinary practices. This finding adds strength to the call for increased residency training in behavioral pediatrics.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Barth R.P.
        Preventing child abuse and neglect with parent training: evidence and opportunities.
        Future Child. 2009; 19: 95-118
        • Collins W.A.
        • Maccoby E.E.
        • Steinberg L.
        • et al.
        Contemporary research on parenting: the case for nature and nature.
        Am Psychol. 2000; 55: 218-232
        • Sanders M.
        Triple P–Positive Parenting Program as a public health approach to strengthening parenting.
        J Fam Psychol. 2008; 22: 506-517
        • Garner A.S.
        • Shonkoff J.P.
        • Committee on Psychosocial Aspects of Child and Family Health
        • Committee on Early Childhood, Adoption, and Dependent Care
        • Section on Developmental and Behavioral Pediatrics
        Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health.
        Pediatrics. 2012; 129: e224-e231
        • Lereya S.T.
        • Samara M.
        • Wolke D.
        Parenting behavior and the risk of becoming a victim and a bully/victim: a meta-analysis study.
        Child Abuse Negl. 2013; 37: 1091-1108
        • Anda R.F.
        • Felitti V.J.
        • Bremmer J.D.
        • et al.
        The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology.
        Eur Arch Psychiatr Clin Neurosci. 2006; 256: 174-186
      1. Center on the Developing Child at Harvard University. The foundations of lifelong health are built early in childhood. 2010. Available at: http://www.developingchild.harvard.edu. Accessed October 22, 2010.

        • Hillis S.D.
        • Anda R.F.
        • Dube S.R.
        • et al.
        The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death.
        Pediatrics. 2004; 113: 320-327
        • Briggs-Gowan M.J.
        • Owens P.L.
        • Schwab-Stone M.E.
        • et al.
        Persistence of psychiatric disorders in pediatric settings.
        J Am Acad Child Adolesc Psychiatry. 2003; 42: 1360-1369
        • Hurlburt M.S.
        • Nguyen K.
        • Reid J.
        • et al.
        Efficacy of the Incredible Years group parent program with families in Head Start who self-reported a history of child maltreatment.
        Child Abuse Negl. 2013; 37: 531-543
        • Kaminski J.W.
        • Perou R.
        • Visser S.N.
        • et al.
        Behavioral and socio-emotional outcomes through age 5 years of the legacy for children public health approach to improving developmental outcomes among children born into poverty.
        Am J Public Health. 2013; 103: 1058-1066
        • Institute of Medicine
        Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities.
        National Academies Press, Washington, DC2009
        • Lundahl B.
        • Risser H.J.
        • Lovejoy M.C.
        A meta-analysis of parent training: moderators and follow-up effects.
        Clin Psychol Rev. 2006; 26: 86-104
        • Nixon R.D.V.
        Treatment of behavior problems in preschoolers: a review of parent training programs.
        Clin Psychol Rev. 2002; 22: 525-546
        • Sanders M.
        • Murphy-Brennan M.
        • McAuliffe C.
        The development, evaluation of a training programme for general practitioners in evidence-based parent consultation skills.
        Int J Ment Health Promot. 2003; 5: 13-20
        • Earls M.F.
        • Hay S.S.
        Setting the stage for success: implementation of developmental and behavioral screening and surveillance in primary care practice—the North Carolina Assuring Better Child Health and Development project.
        Pediatrics. 2006; 118: e183-e188
        • Burklow K.A.
        • Vaughn L.M.
        • Valerius K.S.
        • Schultz J.R.
        Parental expectations regarding discussions on psychosocial topics during pediatric office visits.
        Clin Pediatr. 2001; 40: 555-562
        • Zero to Three
        Parenting Infants and Toddlers Today: Research Findings.
        Hart Research Associates, Washington, DC2009 (Available at:) (Accessed April 5, 2014)
        • Coker T.R.
        • Shaikh Y.
        • Chung P.J.
        Parent-reported quality of preventive care for children at-risk for developmental delay.
        Acad Pediatr. 2012; 12: 384-390
        • Grant E.
        • Macnab A.
        • Wambera K.
        The effectiveness of pediatric residency education in preparing graduates to manage neurological and neurobehavioral issues in practice.
        Acad Med. 2007; 82: 304-309
        • Foy J.M.
        • Kelleher K.J.
        • Laraque D.
        American Academy of Pediatrics Task Force on Mental Health. Enhancing pediatric mental health care: strategies for preparing a primary care practice.
        Pediatrics. 2010; 125: S87-S108
        • Flaherty E.
        • Stirling J.
        • Committee on Child Abuse and Neglect
        Clinical report: the pediatrician’s role in child maltreatment prevention.
        Pediatrics. 2010; 126: 833-841
        • Turner K.M.T.
        • Sanders M.
        Help when it’s needed first: a controlled evaluation of preventative behavioral family intervention in a primary care setting.
        Behav Ther. 2006; 37: 131-142
        • Sanders M.
        • Tully L.
        • Turner K.
        • Maher C.
        Training GPs in parent consultation skills.
        Aust Fam Physician. 2003; 32: 763-768
        • De Graaf I.
        • Speetjens P.
        • Smit F.
        • et al.
        Effectiveness of the Triple P Positive Parenting Program on behavioral problems in children: a meta-analysis.
        Behav Modif. 2008; 23: 714-735
        • Nowak C.
        • Heinrichs N.
        A comprehensive meta-analysis of Triple P–Positive Parenting Program using hierarchical linear modeling: effectiveness and moderating variables.
        Clin Child Fam Psychol Rev. 2008; 11: 114-144
      2. Participant Notes for Primary Care Triple P Provider Training. Milton, Australia: Triple P International Pty Ltd; 2010.

        • Turner K.M.T.
        • Sanders M.R.
        Parent Consultation Skills Checklist.
        Parenting and Family Support Centre, University of Queensland, Brisbane, Australia1996
        • Turner K.M.T.
        • Nicholson J.M.
        • Sanders M.R.
        The role of practitioner self efficacy, training and workplace factors on the implementation of an evidence-based parenting intervention in primary care.
        J Prim Prev. 2011; 32: 95-112
        • Achenbach T.M.
        • Rescorla L.A.
        Manual for the ASEBA Preschool Forms and Profiles.
        University of Vermont, Research Center for Child, Youth and Families, Burlington, VT2000
        • Achenbach T.M.
        • Rescorla L.A.
        Manual for the ASEBA School-Age Forms and Profiles.
        University of Vermont, Research Center for Children, Youth and Families, Burlington, VT2001
        • Jensen P.S.
        • Watanabe H.K.
        • Richters J.E.
        • et al.
        Scales, diagnoses, and child psychopathology: II. Comparing the CBCL and the DISC against external validators.
        J Abnorm Child Psychol. 1996; 24: 151-168
        • Johnston C.
        • Mash E.J.
        A measure of parenting satisfaction and efficacry.
        J Clin Child Psychol. 1989; 18: 167-175
        • Runyan D.K.
        • Dunne M.P.
        • Zolotor A.J.
        • et al.
        The development and piloting of the ISPCAN Child Abuse Screening Tool–Parent version (ICAST-P).
        Child Abuse Negl. 2009; 33: 826-832
        • Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health
        The future of pediatrics: mental health competencies for pediatric primary care.
        Pediatrics. 2009; 124: 410-421