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)
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| 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 |
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 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. |
Clinicaltrials.gov Identifier: NCT01424943
| 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 |
footnote204Negative 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 |
footnote204Negative 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 |
footnote204Negative favors intervention |
| 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 |
footnote204Negative 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 | footnote204Negative 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 | footnote204Negative favors intervention |
| 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 |
footnote204Negative 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 |
footnote204Negative 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 |
footnote204Negative 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 |
footnote204Negative 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 | 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 |
| 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 |
| 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 |
