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Shapiro, C. J., Kilburn, J., & Hardin, J. W. (2014b). Prevention of behavior problems in a selected population: Stepping Stones Triple P for parents of young children with disabilities. Research in Developmental Disabilities, 35(11), 2958–2975. (Study Two)

Model(s) Reviewed: Triple P - Home Visiting: Standard Stepping Stones
Additional sources:

WWHV073857

Shapiro, C. J., Kilburn, J., & Hardin, J. W. Prevention of behavior problems in a selected population: Stepping Stones Triple P for parents of young children with disabilities. Unpublished manuscript.
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial Low Not established on race/ethnicity, SES or baseline measures of the outcome None None
Notes:

This review is of Study Two in this publication. Study One examines the same outcomes and follow-up periods in a different group of participants. The studies differ in that Study One participants did not receive services from a PCAN-trained coordinator. Study One is reported under Shapiro et al. (2014a). Study Two outcomes at the five-month follow-up are eligible for a moderate rating. They have low attrition, but baseline equivalence was not demonstrated on race/ethnicity, SES, or baseline measures of the outcome. Although the analysis controlled for baseline measures of the outcomes, it did not control for race/ethnicity and SES. Controls for all three types of measures would be necessary for a study of this type to receive a high rating. Study Two outcomes at the 12-month follow-up are eligible for a low rating because they have high attrition and baseline equivalence could not be assessed. All models controlled for baseline measures of the outcomes.

Study characteristics
Study participants Caregivers of children age 2 or younger who were eligible for services under the Individuals with Disabilities Education Act (IDEA) Part C and who had no history of child maltreatment were eligible to participate in the evaluation. Families were also required to be on the caseload of an IDEA Part C service coordinator who had been trained in the Preventing Child Abuse and Neglect: Parent-Provider Partnerships in Child Care (PCAN) curriculum, which is designed to facilitate effective communication with caregivers. Caregivers deemed eligible for the study received two initial home visits to review consent forms and complete baseline assessments. At the conclusion of the second home visit, 40 caregivers were randomly assigned (20 to treatment and 20 to control). All caregivers in the study were mothers. Mothers assigned to the treatment group were 32 years old, on average; 45 percent were white and 45 percent were African American. Mothers assigned to the control group were 29 years old, on average; 70 percent were white and 25 percent were African American. Mothers assigned to the control group had significantly lower household incomes than mothers assigned to the treatment group. Outcomes were measured post-treatment (5 months) and at follow-up (12 months). Analytic sample size for the treatment group was slightly lower because of attrition at post-treatment (19 mothers) and at follow-up (18 mothers).
Setting No information was provided.
Intervention services Mothers in the treatment group received Standard Stepping Stones Triple P (SSSTP) in addition to IDEA Part C services delivered by a PCAN-trained coordinator. SSSTP, a level 4 intervention in the Triple P hierarchy, is a variant of Triple P developed for parents of preadolescent children with disabilities. Sessions included an assessment of areas to target for intervention, giving feedback to parents on assessment findings using a guided participatory model, goal setting, providing positive parenting strategies, observation and support of parental implementation of parenting skills, planned activities training to promote generalization, and closure. If a DVD player was available, families watched segments of a training DVD created by the developers of SSSTP. The DVD segments provided information on causes of child behavioral problems and illustrated the parenting strategies. If a DVD player was not available, the SSSTP provider reviewed the relevant sections of the workbook with the parent and demonstrated skills as necessary.
Comparison conditions IDEA Part C services as usual, delivered by a PCAN-trained coordinator. Like those in the treatment group, mothers in the control group received two home visits for baseline assessments before the study began.
Staff characteristics and training Practitioners were trained and accredited SSSTP providers. Two held master’s degrees in social work, two held bachelor’s degrees in social work and were licensed at the bachelor’s level, and one held a bachelor’s degree and had more than 20 years of experience in family services.
Funding sources National Quality Improvement Center on Early Childhood, which is funded by the Office on Child Abuse and Neglect, Administration for Children, Youth, and Families, U.S. Department of Health and Human Services
Author affiliation None of the authors are developers of this model.
Study Registration:

Clinicaltrials.gov Identifier: NCT01424943

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Child Behavior Checklist(CBCL)- externalizing
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 52.42 Adjusted mean = 54.80 Mean difference = -2.38 HomeVEE calculated = -0.21 Not statistically significant,
p = 0.41

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Child Behavior Checklist(CBCL)- internalizing
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 48.16 Adjusted mean = 51.25 Mean difference = -3.09 HomeVEE calculated = -0.32 Not statistically significant,
p = 0.27

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Child Behavior Checklist(CBCL)- total problems
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 51.42 Adjusted mean = 54.90 Mean difference = -3.48 HomeVEE calculated = -0.31 Not statistically significant,
p = 0.37

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Depression Anxiety Stress Scales—Short Form (DASS-21) - Depression
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 2.63 Adjusted mean = 4.10 Mean difference = -1.47 HomeVEE calculated = -0.30 Not statistically significant,
p = 0.08

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Depression Anxiety Stress Scales—Short Form (DASS-21) - Anxiety
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT - Study 2 5 months 39 parents Adjusted mean = 3.58 Adjusted mean = 3.00 Mean difference = 0.58 HomeVEE calculated = 0.11 Not statistically significant, p = 0.69

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Depression Anxiety Stress Scales—Short Form (DASS-21) - Stress
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT - Study 2 5 months 39 parents Adjusted mean = 9.26 Adjusted mean = 8.40 Mean difference = 0.86 HomeVEE calculated = 0.11 Not statistically significant, p = 0.62

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Keys to Interactive Parenting Scale (KIPS)
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 3.80 Adjusted mean = 3.43 Mean difference = 0.37 HomeVEE calculated = 0.46 Not statistically significant,
p = 0.06
Moderate Parenting Scale (PS) - Hostility
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 1.55 Adjusted mean = 1.71 Mean difference = -0.16 HomeVEE calculated = -0.21 Not statistically significant,
p = 0.43

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Parenting Scale (PS) - Laxness
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 2.40 Adjusted mean = 2.64 Mean difference = -0.24 HomeVEE calculated = -0.27 Not statistically significant,
p = 0.17

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Parenting Scale (PS) - Over-reactivity
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 2.00 Adjusted mean = 2.47 Mean difference = -0.47 HomeVEE calculated = -0.41 Not statistically significant,
p = 0.78

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Parenting Scale (PS) - Total
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 2.15 Adjusted mean = 2.49 Mean difference = -0.34 HomeVEE calculated = -0.47 Not statistically significant,
p = 0.20

footnote204

Submitted by user on Fri, 03/15/2019 - 14:29

Negative favors intervention

Moderate Toddler Care Questionnaire (TCQ)
FavorableUnfavorable or ambiguousNo Effect
SSSTP RCT -Study 2 5 months 39 parents Adjusted mean = 165.89 Adjusted mean = 161.63 Mean difference = 4.26 HomeVEE calculated = 0.26 Not statistically significant,
p = 0.93

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

Child Behavior Checklist (CBCL)- externalizing

Subscale of the 99-item Child Behavior Checklist

Parent report

Test-retest reliability for entire scale = 0.85

Child Behavior Checklist (CBCL)- internalizing

Subscale of the 99-item Child Behavior Checklist

Parent report

Test-retest reliability for entire scale = 0.85

Child Behavior Checklist (CBCL)- total problems

99-item Child Behavior Checklist

Parent report

Test-retest reliability for entire scale = 0.85

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Depression Anxiety Stress Scales—Short Form (DASS-21)

21-item measure that assesses symptoms of depression, anxiety, and stress

Maternal report

α = 0.92-0.95

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

Keys to Interactive Parenting Scale (KIPS)

Structured observation toll that assesses the quality of parenting behaviors during free play

Observer report

Not reported

Parenting Scale (PS) - Hostility

Subscale of 30-item assessment of dysfunctional parental discipline styles

Parent report

α = 0.80-0.85

Parenting Scale (PS) - Laxness

Subscale of 30-item assessment of dysfunctional parental discipline styles

Parent report

α = 0.80-0.85

Parenting Scale (PS) - Over-reactivity

Subscale of 30-item assessment of dysfunctional parental discipline styles

Parent report

α = 0.80-0.85

Parenting Scale (PS) - Total

30-item assessment of dysfunctional parental discipline styles

Parent report

α = 0.80-0.85

Toddler Care Questionnaire (TCQ)

37-item measure assessing maternal confidence in managing developmental issues for toddlers

Not reported

Not reported