Evidence-based Parenting Support Research Articles

Parenting, Child Maltreatment, and Social Disadvantage: A Population-Based Implementation and Evaluation of the Triple P System of Evidence-Based Parenting Support.

Child Maltreatment (CM) is a widespread public health problem, with adverse outcomes for children, families, and communities. Evidence-based parenting support delivered via a public health approach may be an effective means to prevent CM. The Every Family 2 population trial applied a public health approach to delivering evidence-based parenting support to prevent CM in disadvantaged communities. Using a quasi-experimental design, 64 matched low socioeconomic communities in the Australian states of Queensland and New South Wales received either the full multi-level Triple P system (TPS) of parenting support, or Care as Usual (CAU). Two population indicators of CM, the number of substantiated cases of CM, and the number of notifications of CM to protective services were compared using Welch's t-test to evaluate intervention effectiveness. After two years of intervention, medium to large effect sizes favoring TPS communities were found for substantiations (d = 0.57, p < .05) and notifications (d = 1.86, p < .001). These findings show the value of the TPS, deployed using a public health approach, in efforts to prevent CM in socially disadvantaged communities. A number of uncontrolled contextual factors are described that may have contributed to some of the differences detected between TPS and CAU communities.

A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial

BackgroundEvidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group.MethodsThis study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10–17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff.DiscussionApp-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings.Trial registrationThe trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ.

The thriving kids and parents schools project: protocol of an incomplete stepped wedged cluster randomised trial evaluating the effectiveness of a Triple P seminar series

BackgroundThe COVID-19 pandemic disrupted the normality of daily life for many children, their families, and schools, resulting in heightened levels of anxiety, depression, social isolation, and loneliness among young people. An integrated public health model of interventions is needed to address the problem and to safeguard the mental health and wellbeing of children. The Triple P – Positive Parenting Program is one system of parenting support with a strong evidence-base and wide international reach. When implemented as a public health approach, Triple P has demonstrated population level positive effects on child wellbeing. This study will be the first large-scale, multi-site randomised controlled trial of a newly developed, low-intensity variant of Triple P, a school-based seminar series, as a response to the impacts of the pandemic.MethodsThe evaluation will employ an Incomplete Batched Stepped Wedge Cluster Randomised Trial Design. At least 300 Australian primary schools, from South Australia, Queensland, and Victoria will be recruited and randomised in three batches. Within each batch, schools will be randomly assigned to either start the intervention immediately or start in six weeks. Parents will be recruited from participating schools. The Triple P seminar series includes three seminars titled: “The Power of Positive Parenting”, “Helping Your Child to Manage Anxiety”, and “Keeping your Child Safe from Bullying”. Parents will complete measures about child wellbeing, parenting, parenting self-regulation and other key intervention targets at baseline, six weeks after baseline, and 12 weeks after baseline. Intervention effectiveness will be evaluated with a Multilevel Piecewise Latent Growth Curve Modelling approach. Data collection is currently underway, and the current phase of the project is anticipated to be completed in January 2024.DiscussionThe findings from this study will extend the current knowledge of the effects of evidence-based parenting support delivered through brief, universally offered, low intensity, school-based parenting seminars in a post pandemic world.Trial registrationThe trial is registered at the Australian New Zealand Clinical Trials Registry (Trial Registration Number: ACTRN12623000852651).

Changes in coercive parenting and child externalizing behavior across COVID-19 and the moderating role of parent-child attachment relationship quality.

Research indicates increases in coercive parenting towards children and increases in child externalizing behavior during COVID-19 as compared to the pre-pandemic period. In this preregistered study, we extended previous knowledge by investigating to what extent, and under what conditions, changes in coercive parenting and child externalizing behavior are interrelated. Ninety-five mothers and fathers of children (of age 3 prior to the pandemic) reported on coercive parenting and child externalizing behavior before and during the pandemic, and trained assistants observed the quality of mother-child and father-child attachment relationship prior to the pandemic. We employed latent change score modeling to test the extent to which changes in maternal and paternal coercive parenting and changes in child externalizing behavior across the pre-pandemic period and the onset of the first COVID-19 lockdown are interrelated. Moreover, we tested whether these linkages are moderated by changes in the other parent's coercive parenting and the quality of parent-child attachment relationship. Specifically, we tested the moderation by mother-child (father-child) attachment relationship quality in the relation between changes in mothers' (fathers') coercive parenting and changes in child externalizing behavior. We found that changes in mothers', but not fathers' coercive parenting were positively associated with changes in child externalizing behavior. We found no moderation by changes in the other parent's parenting or by parent-child attachment relationship quality. Our findings provide support for the transactional processes underlying mothers' and children's behavior in the context of non-normative stressful conditions. We recommend incorporating evidence-based (parenting) support for mothers, fathers, and young children in prevention strategies and recovery tools employed during and after future lockdowns and non-normative stressful events.

The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions

Triple P is an integrated, multi-level system of evidence-based parenting support designed to promote the well-being of children and families to reduce prevalence rates of social, emotional, and behavioral problems in children and adolescents and to prevent child maltreatment. The system developed gradually over four decades to address the complex needs of parents and children from diverse family, socioeconomic and cultural backgrounds. It blends universal and targeted programs, a focus on developing parental self-regulation capabilities, and adopts a life span perspective with a population health framework. The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention. Seven stages of program development are outlined from initial theory building and development of the core parenting program through to the sustained deployment of the intervention system delivered at scale. The importance of ongoing research and evaluation is highlighted so that different programs within the system evolve and adapt to address the contemporary concerns and priorities of families in diverse cultural contexts. A well-trained workforce is essential to deliver evidence-based programs, in a need-responsive manner that blends both fidelity of delivery and flexibility and is tailored to respond to the needs of individual families and local context. Programs need to be gender-sensitive, culturally informed, and attuned to the local context including relevant policies, resources, cultural factors, funding, workforce availability and their capacity to implement programs.

‘It provides practical tips, practical solutions!’: acceptability, usability, and satisfaction of a digital parenting intervention across African countries

ABSTRACT The parenting evidence base is well established, and the question is how best to transfer the evidence to an app. App-based interventions could expand access to evidence-based parenting support; however, current provision lacks rigorous evidence, shows low user engagement, and is primarily for commercial gain. This study aimed at testing the feasibility and acceptability of ParentApp for Teens, an open-source, mobile parenting intervention application based on the Parenting for Lifelong Health Teens programme targeting parents of teens. The objective was to gather feedback from users on the relevance, acceptability, satisfaction, and usability of ParentApp for Teens across contexts in Africa, and subsequently, use the feedback to improve the app experience for target users. Caregivers and their adolescents aged 10–17 years, from nine different countries, were purposefully selected for user testing. The study involved 18 caregivers participating in the programme by using the app for 13 weeks and providing feedback on it through remote, semi-structured interviews that explored the app’s acceptability and usability. Adolescents of six caregivers were also interviewed. Data were analysed thematically. Participants expressed a high level of satisfaction with the app’s content and described it as easy to use and useful. However, views on the app’s animated characters varied. Although effectiveness was not a primary aim of the user testing, several caregivers commented that they perceived their participation in the study had helped to enforce positive parenting skills in themselves. Adolescents’ data supported the caregivers’ reports of less harsh parenting and improved relationships between caregivers and their children due to the caregivers’ participation in the study. Findings indicate the app could be relevant and acceptable in participants’ communities, but possible barriers to its uptake may be lack of android smartphones, lack of data for app download, and inability of non-literate caregivers to read the content.

Successful implementation of parenting support at preschool: An evaluation of Triple P in Sweden.

Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff “buy-in”, designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.

Mechanisms of Change in Population-Based Parenting Interventions for Children and Adolescents

ABSTRACT Objective Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes. Method Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention. Results A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved. Conclusions Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.

Delivering evidence-based parenting support in educational settings

Parent-child relationships influence learning throughout a child’s formal schooling and beyond. The quality of parenting children receive has a major influence on their learning and developmental capabilities. Parental influence is important in the early years of life and extends throughout a child’s schooling. Parenting has a pervasive influence on children’s language and communication, executive functions and self-regulation, social and peer relationships, academic attainment, general behaviour and enjoyment of school. Schools can further enhance educational outcomes for students by developing the resources and expertise needed to engage parents as partners in learning. This can be achieved by delivering and facilitating access to a comprehensive system of high-quality, culturally informed, evidence-based parenting support programs. In this article, recent developments in the Triple P system of parenting support are used to illustrate how schools can develop a low-cost, comprehensive, high-quality parenting support strategy that blends universal components with targeted components for more vulnerable children. We identify potential organisational and logistical barriers to implementing parenting support programs and ways to address these.

COVID-19-Associated Orphanhood andCaregiver Death in the UnitedStates.

Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations. We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.

Mother of a problem! Are the Needs of Mothers with Intellectual Disability Being Addressed in the NDIS Era?

The National Disability Insurance Scheme was introduced to provide a rights-based entitlement to support for Australians with disability, replacing the previous welfare-based policy framework. However, there are indications this rights-based support has not eventuated for mothers with intellectual disability, with growing reports of their reduced access to the parenting support to which they are entitled under the Convention on the Rights of Persons with Disability. Despite the NDIS promise of an equitable disability care system that would seamlessly complement State-funded services, reports from mothers with intellectual disability and their advocates suggest that cost-shifting between the Commonwealth and State Governments has reinforced service silos and opened up service gaps for a group of women who need support from both the disability and family support systems. Moreover, a concerning absence of reliable, transparent data makes it difficult to monitor the wellbeing of families headed by mothers with intellectual disability and also suggests these families are no longer a priority for Australian Governments. In this commentary, we advocate for: i) publicly available data on how the NDIS identifies and addresses the support needs of mothers with intellectual disability; ii) the integration of State and Commonwealth funding mechanisms to enable mothers with intellectual disability to access a parenting supplement linked to their NDIS funding and; iii) the rebuilding of national capacity in evidence-based parenting education and support to mothers with intellectual disability across all Australian service systems.

Scaling Up Parenting Interventions is Critical for Attaining the Sustainable Development Goals.

Of all the potentially modifiable influences affecting children’s development and mental health across the life course, none is more important than the quality of parenting and family life. In this position paper, we argue that parenting is fundamentally linked to the development of life skills that children need in order to achieve the United Nations Sustainable Development Goals. We discuss key principles that should inform the development of a global research and implementation agenda related to scaling up evidence-based parenting support programs. Research over the past 50 years has shown that parenting support programs of varied intensity and delivery modality can improve a wide range of developmental, emotional, behavioral and health outcomes for parents and their children. Such findings have been replicated across culturally and socioeconomically diverse samples, albeit primarily in studies from Western countries. We highlight the evidence for the relevance of parenting interventions for attaining the SDGs globally, and identify the barriers to and strategies for achieving their scale-up. The implications of the global COVID-19 pandemic for the delivery of evidence-based parenting support are also discussed.

An Evaluation of an Integrated Stuttering and Parent-Administered Self-Regulation Program for Early Developmental Stuttering Disorders.

Purpose This study reports findings from a clinical trial that implemented an early stuttering treatment program integrated with evidence-based parenting support (EBPS) to children who stutter (CWS) with concomitant self-regulation challenges manifested in elevated attention-deficit/hyperactivity disorder (eADHD) symptoms and compared those outcomes to CWS receiving stuttering treatment without EBPS. Method Participants were 76 preschool CWS and their parent(s). Thirty-six of these children presented with eADHD and were quasirandomized into two groups: stuttering treatment only (eADHDstandard) or stuttering treatment integrated with EBPS (eADHDintegrated). The remaining children did not meet criteria for eADHD symptoms and received stuttering treatment only (No-eADHDstandard). Pre, post, and 3-month follow-up measures of stuttering treatment outcomes as well as treatment effects on measures of child behavior difficulties and parenting practices were examined. Results Significant reduction in stuttering was found for all groups. However, the eADHDintegrated group showed a greater reduction in stuttering frequency than the eADHDstandard group, and at follow-up, stuttering frequencies in the eADHDintegrated group matched those of children in the No-eADHDstandard group, while stuttering in the eADHDstandard group remained significantly higher. Children with eADHD symptoms who received the integrated program also required significantly less stuttering intervention time than those children with eADHD symptoms who received stuttering treatment only. Families in the eADHDintegrated group reported large and significant improvements in child behavior and parenting practices. Conclusion This study provides support for an early treatment program for CWS. The integrated stuttering and self-regulation management program for CWS with eADHD symptoms proved successful for fluency and behavioral improvements, which were sustained at follow-up.

Harnessing the Power of Positive Parenting to Promote Wellbeing of Children, Parents and Communities Over a Lifetime

Evidence-based parenting support (EBPS) programs derived from social learning theory, cognitive behavioural principles, and developmental theory are among the most successful innovations in the entire field of psychological intervention. EBPS programs have been at the cutting edge of global dissemination efforts to increase community access to evidence-based parenting programs. Despite the widely recognised success of these efforts, existing models of parenting intervention are not a panacea, and much can be done to improved outcomes. Efforts to improve outcomes have included the emergence of a population-based approach to increase reach of intervention. This has included the development of flexible delivery modalities, including online parenting interventions, the incorporation of strategies to enhance cultural relevance and acceptability of programs, and more recently, applications with parents in very low resource settings. Further enhancements of outcomes are likely to be forthcoming as we gain a better understanding of the mechanisms that explain positive intervention effects and non-response to interventions. More cost-effective online professional training models are needed to disseminate and promote the sustained use of EBPS programs. New interventions are required for the most vulnerable parents when parenting concerns are complicated by other problems such as trauma, addictions, relationship conflict, family violence, mental health problems and intergenerational poverty. However, to scale effective programs, Commonwealth and state government policies and funding priorities need to respond to evidence about what works and make sustained investments in the implementation of parenting programs. Possible strategies to enhance the policy impact of intervention research are discussed.

Parental Determinism in the Swedish Strategy for Parenting Support

This article analyses and problematises central assumptions in Sweden's National Strategy for Developing Parenting Support, a document that addresses children's deteriorating psychological health. The analysis was performed with Bacchi's (2009) approach to policy analysis. The results show how parental determinism is expressed; psychological ill health among school-aged children is described as an individualised problem caused by insecure parents, who are represented as the most important persons in a child's life and, therefore, are considered to be risk factors that require continuous support. Evidence-based parenting support programmes in particular are described as a central tool for improving parents’ sense of responsibility and parenting skills. While the strategy aims to offer all Swedish parents support, it underlines ideals that have been related to gendered, middle-class notions of parenting. The issue concerning children's psychological health is problematised and discussed in relation to parental determinism, the risk society, equality, equity and psychological health.

Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities

This paper evaluates program, workplace and process factors associated with implementation and sustainment of an evidence-based parenting support program (EBP) in disadvantaged communities. Correlation analyses and binary logistic regressions were used to assess the associations between key implementation support factors and program implementation (at 18 months) and sustainment (at 36 months) post training with (N=35) Australian Aboriginal and Torres Strait Islander family support providers using the Triple P – Positive Parenting Program in Indigenous child protection agencies. This study demonstrated that for implementation at 18 months, there was a trend for implementing providers to report higher levels of partnership support, perceived program benefit, workplace support and workplace cohesion. However, the only significant relationship was with partnership support (r=.31 p<0.05), and regression analysis indicated that none of the variables were significant predictors of program implementation. For sustained implementation at 36 months, no relationship was found between sustainment and program characteristics, workplace characteristics, supervision and peer support or sustainability planning. Supportive coaching was the only significant correlate (r=0.46, p<0.01) and predictor [OR=15.63, 95% CI (1.98–123.68), p=0.009] in the program sustainment model. Overall, these findings suggest the need for further exploration of program and workplace variables and provide evidence to consider incorporating partnership support and supportive coaching in real world implementation models to improve the likelihood of EBP implementation and sustainment in Indigenous communities.

An Evaluation of the Online Universal Programme COPING Parent: A Feasibility Study.

Background:COPING parent (Confident Parent Internet Guide) is an online universal parenting programme designed for parents of children aged 3-8 who are interested in learning positive parenting strategies to address everyday parenting challenges. Most people now have access to the internet and many parents seek online parenting advice, so it is important to ensure that advice is both evidence-based and freely available. The 10-week online COPING parent programme presents information and activities based on core social learning theory principles. The programme provides information and video examples of parenting skills, uses quizzes to test knowledge and suggests home practice activities. This study was undertaken to obtain feedback on the usefulness and acceptability of the programme to inform its further development.Design and Methods:The programme was created using the LifeGuide software and participants (n=20) were asked to complete one chapter of the programme each week and provide feedback. This feasibility study was undertaken to highlight any technical issues and suggest modifications prior to a more rigorous evaluation.Results:Both participant feedback and programme usage data are reported. Thirteen feedback forms were returned and programme usage data was downloaded for all participants. Feedback suggested modifications that included adaptations to enable the programme to be accessed by tablet users, an option to look back over previously completed chapters, the inclusion of more video examples of positive parenting and text message prompting to address attrition challenges.Significance for public healthGood quality parenting is associated with positive child outcomes, including increased social and emotional competence, pro-social behaviour and well being; therefore providing evidence-based parenting support is potentially a useful way of promoting positive child development. Whilst there are evidence-based services for parents of children with identified behavioural and other developmental problems, there is less reliable support for parents in general. Most parents do not receive evidence-based advice on dealing with common everyday parenting challenges, as there are fewer public health resources available for parents in general. The changing patterns of family life have increased the demands on all parents and many now seek advice online, therefore universal web-based provision may be a useful public health tool to equip parents with the skills to practice positive parenting, address everyday parenting challenges, encourage positive child behaviour, achieve good child outcomes and avoid problems becoming more severe.

Who Uses Online Parenting Support? A Cross-Sectional Survey Exploring Australian Parents’ Internet Use for Parenting

The need for better access to evidence-based parenting interventions is widely recognized, as few families actually participate in parenting programs. A public health approach that includes the delivery of parenting information via the Internet could increase the reach of such interventions dramatically. However, there are concerns that web-based information is not accessible by families that face the greatest barriers to accessing “traditional” face-to-face parenting support, and therefore could benefit most from online approaches. This study used a cross-sectional survey of 459 Australian parents of 2–12 year olds to investigate parents’ use of the Internet to access parenting information, and the extent to which this information is useful for parents from a range of socio-economic backgrounds. Results indicate that the majority of parents use parenting websites (65 %) and social media (45 %) for parenting information. Users of parenting websites tended to be parents of younger children. Younger age of the child was also associated with using social media, as was younger parental age, being female, not working and spending more hours online. Parents rated a range of modalities as useful for receiving parenting information, particularly seminars and individually tailored programs. Self-directed web-based programs were endorsed by 61 % of respondents. Higher-risk parents were as likely or more likely to endorse web-based information sources as lower-risk parents. As there was almost equal access to online parenting information among families from different backgrounds, we conclude that the Internet provides an exciting opportunity for delivering evidence-based parenting support to a broad range of parents, including higher-risk families.

From parent to ‘peer facilitator’: a qualitative study of a peer‐led parenting programme

Peer-led interventions are increasingly common in community health settings. Although peer-led approaches have proven benefits for service users, relatively little is known about the process and outcomes of participation for peer leaders. This study investigated experiences of parents who had participated as 'peer facilitators' in Empowering Parents, Empowering Communities (EPEC), a peer-led programme designed to improve access to evidence-based parenting support in socially disadvantaged communities. A qualitative cross-sectional design was used. Semi-structured interviews were conducted with 14 peer facilitators and scrutinized using thematic analysis. Peer facilitators developed their knowledge and skills through personal experience of receiving parenting support, participation in formal training and supervised practice, access to an intervention manual, and peer modelling. Peer facilitators described positive changes in their own families, confidence and social status. Transformative personal gains reinforced peer facilitators' role commitment and contributed to a cohesive 'family' identity among EPEC staff and service users. Peer facilitators' enthusiasm, openness and mutual identification with families were seen as critical to EPEC's effectiveness and sustainability. Peer facilitators also found the training emotionally and intellectually demanding. There were particular difficulties around logistical issues (e.g. finding convenient supervision times), managing psychosocial complexity and child safeguarding. The successful delivery and sustained implementation of peer-led interventions requires careful attention to the personal qualities and support of peer leaders. Based on the findings of this study, support should include training, access to intervention manuals, regular and responsive supervision, and logistical/administrative assistance. Further research is required to elaborate and extend these findings to other peer-led programmes.

Parenting interventions and the prevention of serious mental health problems in children.

The reduction of coercive or inadequate parenting is essential if the mental health status of Australian children and adolescents is to be improved. Of the available approaches that address parenting practices, behavioural family interventions have the strongest empirical support and are effective in reducing parenting practices that contribute to the development of behavioural and emotional problems in children. However, only a small proportion of parents access such interventions. A comprehensive multilevel, evidence-based parenting and family support strategy needs to be implemented on a wide scale to reduce the prevalence of mental health problems in children and youth. The Triple P - Positive Parenting Program is an example of a population-level strategy that can be used to improve the mental health status of children and their parents.