Stepping Stones Triple P: the importance of putting the findings into context--a response to Tellegen and Sofronoff.

Sijmen A Reijneveld,Marijke Kleefman,Daniëlle Emc Jansen

doi:10.1186/s12916-015-0289-4

Abstract

Recently, we reported the findings of a randomized controlled trial on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU), in BMC Medicine. The study involved parents of 209 children with Borderline to Mild Intellectual Disability (BMID), included following a school-based assessment of psychosocial problems. We found that SSTP had some short-term advantages over CAU, i.e., a reduction of parenting stress and of teacher-reported psychosocial problems, but no long-term advantages, at 6 months after the intervention. Tellegen and Sofronoff criticized that we included a limited amount of studies on the effectiveness of SSTP, and that the interpretation of our findings was inadequate. Regarding available evidence, we confined our summary to published high-quality RCTs regarding individual SSTP on level 4 – our RCT concerned that type of SSTP. Consequently, many studies were excluded but in a very adequate way. Regarding interpretation, Tellegen and Sofronoff criticized that we compared SSTP with CAU, but seem to be unware that this is consonant with current guidelines. Moreover, they noted that 49% of the parents who started SSTP followed less than half of the intended number of sessions. However, our findings on those who completed SSTP showed no more advantages of SSTP in the long term than CAU. We therefore stick to our conclusion that SSTP has some advantages in the short term compared to CAU, but not in the long term. The major burden of psychosocial problems in children with BMID prompts for further improvements.Please see related articles: http://www.biomedcentral.com/1741-7015/12/191 and http://www.biomedcentral.com/1741-7015/13/25

Highlights

In a recent paper in BMC Medicine, we reported the findings of a randomized controlled trial (RCT) on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU) [1]
They indicate that examination of the mean scores on the measures shows that the lack of long-term effects might be explained by outcomes in the CAU group continuing to improve over the follow-up period. They further indicate that, in contrast, the parents in the SSTP group maintained improvements that were seen at short-term, and both groups showed some improvement. These notions are fully consonant with our interpretation of the findings: SSTP may improve the outcomes of children and families somewhat, but in the long term, it does not do that in a better way than the routine Dutch CAU for children with psychosocial problems
In short, we highly appreciate the willingness of Tellegen and Sofronoff to enter the public debate on the effectiveness of SSTP, but we disagree on their critical reflection regarding the potential weaknesses of our RCT

Summary

Introduction

In a recent paper in BMC Medicine, we reported the findings of a randomized controlled trial (RCT) on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU) [1]. Background In a recent paper in BMC Medicine, we reported the findings of a randomized controlled trial (RCT) on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU) [1].

Results

Conclusion