Self-directed behavioural family intervention.

Abstract

Abstract Behavioural family intervention is effective for the prevention and treatment of a wide range of emotional and behavioural problems in children. There is a growing need to address the accessibility of these services. This paper reviews the literature on self-directed interventions designed to help parents manage difficult child behaviours. Evidence regarding the efficacy of interventions is reviewed, and some of the difficulties associated with self-directed programs are discussed. The Self-directed Triple P Program is highlighted as an example of an efficacious and effective behavioural family intervention fitting into a larger multi-level model of family intervention. The discussion of the efficacy and effectiveness of self-directed interventions has implications for service delivery of parenting programs. Keywords: self-directed, behavioural family intervention, parenting, children. ********** Parenting interventions attempt to enhance a parent's understanding of child behaviour management and the quality of the parent-child interactions, with the ultimate goal of optimising the child's developmental course (Cowan, Powell, & Cowan, 1998). When parents are taught to use consistent, moderate, and firm discipline, their children exhibit fewer behaviour problems (Arnold & O'Leary, 1997; Forehand, Wells, & Griest, 1980; Webster-Stratton, Kolpacoff, & Hollinsworth, 1988). Behavioural family interventions (BFI) aim to effect change in children's behaviour and adjustment by modifying aspects of the family environment that maintain and reinforce a child's problem behaviours (Sanders, 1992). There is substantial evidence that BFI, particularly therapist-directed BFI, produces significant changes in both parents and children immediately following treatment (Forehand, Griest, & Wells, 1979) and there is good maintenance of treatment gains and generalisation of these skills (Dadds, Sanders, & James, 1983; Forehand & Long, 1988). There is also evidence for the generalisation of intervention effects beyond the specific behaviours and settings addressed during treatment (Sanders & Glynn, 1981; Serkettich & Dumas, 1996). Furthermore, BFI has effects ranging beyond improvements in child behaviour. Effects have been shown for decreases in parental depression (Connell, Sanders, & Markie-Dadds, 1997; Forehand et al., 1980), anxiety, and stress (Connell et al., 1997). Finally, in general, parents report high levels of satisfaction with behavioural family interventions and find the programs socially acceptable (Forehand et al., 1980; McMahon & Forehand, 1983; Webster-Stratton, 1989). While there is significant evidence to support the efficacy of BFI, there are a number of factors that limit its dissemination at a community level. Firstly, very low numbers of parents participate in any form of parent education (Sanders et al., 1999) and there is generally low participation by parents of children who have significant behaviour problems (Zubrick et al., 1995) or whose children are believed to be at greatest risk of developing serious behaviour or emotional problems (Harachi, Catalano, & Hawkins, 1997). In Australia, while approximately 18% of children experience an identifiable mental health problem, only 2% of children receive any form of treatment from specialist mental health practitioners (Zubrick & Silburn, 1994) and only 10% of parents participate in parenting education (Sanders et al., 1999). Secondly, there is a range of psychological and cultural implications to seeking help, with great stigma attached to perceived difficulties with coping (Cunningham, 1996). The logistics of attending sessions, either individual or group, such as work schedules, extracurricular activities, difficulties arranging childcare, travel time, and transport costs may prevent many parents from participating in interventions (Cunningham, 1996; Pavuluri, Luk, & McGee, 1996; Spoth, Redmond, Hockaday, & Shin, 1996). …