Trevor G. Mazzucchelli

Behavioral family intervention for children with developmental disabilities and behavioral problems

The outcomes of a randomized clinical trial of a new behavioral family intervention, Stepping Stones Triple P, for preschoolers with developmental and behavior problems are presented. Forty-eight children with developmental disabilities participated, 27 randomly allocated to an intervention group and 20 to a wait-list control group. Parents completed measures of parenting style and stress, and independent observers assessed parent-child interactions. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. All effects were maintained at 6-month follow-up.

Behavioral activation interventions for well-being: A meta-analysis

One of the most promising ways to increase well-being is to engage in valued and enjoyable activities. Behavioral activation (BA), an intervention approach most commonly associated with the treatment of depression, is consistent with this recommendation and can easily be adapted for non-clinical populations. This study reports on a meta-analysis of randomized controlled studies to examine the effect of BA on well-being. Twenty studies with a total of 1353 participants were included. The pooled effect size (Hedgess g) indicated that the difference in well-being between BA and control conditions at posttest was 0.52. This significant effect, which is comparable to the pooled effect achieved by positive psychology interventions, was found for non-clinical participants and participants with elevated symptoms of depression. Behavioral activation would seem to provide a ready and attractive intervention for promoting the well-being of a range of populations in both clinical and non-clinical settings.

Stepping Stones Triple P: the theoretical basis and development of an evidence‐based positive parenting program for families with a child who has a disability

Stepping Stones Triple P is the first in a series of programs based on the Triple P – Positive Parenting Program that has been specifically designed for families who have a child with a disability. This paper presents the rationale, theoretical foundations, historical development and distinguishing features of the program. The multi‐level intervention adopts a self‐regulation framework in consulting with parents that involves the promotion of parental self‐sufficiency, self‐efficacy, self‐management skills, personal agency and problem‐solving skills. This paper describes the key program design features, intervention techniques, model of clinical consultation, its clinical applicability, and empirical base. The 10‐session individually administered version of the program, known as Standard Stepping Stones Triple P is described and the important role of training, supervision and agency support in disseminating the program is discussed.

The promotion of self-regulation through parenting interventions

The capacity for a parent to self-regulate their own performance is argued to be a fundamental process underpinning the maintenance of positive, nurturing, non-abusive parenting practices that promote good developmental and health outcomes in children. Deficits in self-regulatory capacity, which have their origins in early childhood, are common in many psychological disorders, and strengthening self-regulation skills is widely recognised as an important goal in many psychological therapies and is a fundamental goal in preventive interventions. Attainment of enhanced self-regulation skills enables individuals to gain a greater sense of personal control and mastery over their life. This paper illustrates how the self-regulatory principles can be applied to parenting and family-based interventions at the level of the child, parent, practitioner and organisation. The Triple P—Positive Parenting Program, which uses a self-regulatory model of intervention, is used as an example to illustrate the robustness and versatility of the self-regulation approach to all phases of the parent consultation process.

Early Intervention for Behaviour Problems in Young Children with Developmental Disabilities

This article reviews research on intervention for young children with dual developmental and behavioural problems. It makes a case for intervention to include family variables and to occur in the preschool years. Behaviour problems are common in young children with developmental disabilities. If untreated these problems are likely to persist and become more challenging and severe in adulthood. Behaviour problems interfere with cognitive, social and emotional development, create additional family stress, often lead to exclusion from community services, and result in additional financial costs to the community. Intervention research provides some support for the effectiveness of parent management training and interventions based upon applied behaviour analysis. However, randomised controlled trials with adequate follow-up periods are required, along with the measurement of outcomes for the family as a whole.

Preventing behavioural and emotional problems in children who have a developmental disability: A public health approach

Children with developmental disabilities are at substantially greater risk of developing emotional and behavioural problems compared to their typically developing peers. While the quality of parenting that children receive has a major effect on their development, empirically supported parenting programs reach relatively few parents. A recent trend in parenting intervention research has been the adoption of a public health approach to improve the quality of parenting at a population level. This has involved delivering parenting interventions on a large scale and in a cost-effective manner. Such trials have been demonstrated to reduce negative parenting practices, prevent child maltreatment, and reduce child behavioural and emotional problems. However, these trials have been restricted to parents of children who are developing typically. This paper explores the rational for the extension of a population health approach to parenting interventions for children with developmental disabilities. It is argued that a population-based implementation and evaluation trial of an empirically supported system of interventions is needed to determine whether this approach is viable and can have a positive impact on parents and their children in a disability context. The Stepping Stones Triple P--Positive Parenting Program is presented as an example of a parenting intervention that satisfies the requirements for such a trial. Tasks and challenges of such a trial are discussed.

A commentary on evidenced-based parenting programs: redressing misconceptions of the empirical support for Triple P

A meta-analytic review of the Triple P-Positive Parenting program by Wilson et al., recently published in BMC Medicine, claimed to demonstrate that although Triple P is widely disseminated and adopted, the evidence attesting to the effectiveness of the program is not as convincing as it may appear. Although this review addresses the important issue of evaluation and reporting methods within evidence-based interventions, we contend that the Wilson et al. review contains a number of significant conceptual, methodological and interpretational inadequacies that render the key conclusions of their review problematic.

Group behavioural activation and mindfulness therapy for the well-being of non-clinical adults: a preliminary open trial

Using 16 non-clinical adults from the community, this study examined the effects on well-being of a group intervention consisting of a 4-week behavioural activation component followed by a 3-week mindfulness component, finishing with an integrating closure session. Results from intention-to-treat analyses showed moderate and significant improvements in psychological distress and several indices of well-being after the behavioural activation component. These improvements continued through the mindfulness component of the intervention such that effects were greater after participants had received the complete intervention. Half of the participants reported reliable and clinically significant improvement in the amount of time they felt happy after the intervention and a quarter of participants reported improvement at follow-up. Behavioural activation and mindfulness interventions may provide a useful framework for further research with non-clinical populations who wish to enhance their wellbeing and learn skills that may protect them against depression and other mental health problems.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up

Aim To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). Design A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The “control” group received “Training as Usual” (TAU). Method Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. Results We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program. Conclusion While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583

Trauma exposure and post‐traumatic stress disorder within fire and emergency services in Western Australia

Abstract Objective While it is widely accepted that fire and emergency work is of high risk for potentially traumatic event exposure and post‐trauma pathology, there has been limited published data regarding Australian fire and emergency service workers. The relationship between trauma exposure and mental health outcomes, in particular the significance of social support and coping style was explored. Method Participants were 210 Department of Fire and Emergency Services (DFES) career firefighters in Western Australia (WA). This study employed a cross‐sectional, correlational design, with a combination of self‐selection and random sampling. Results Results found that DFES career members were exposed to trauma at significantly higher rates than the general population and reported elevated rates of post‐traumatic stress disorder (PTSD) symptomatology. Trauma exposure, social support, and coping style significantly contributed to variation in PTSD symptomatology, with maladaptive coping strategies accounting for more PTSD variance than adaptive coping. Conclusions Elevated rates of PTSD identify WA DFES members as a high risk population. There was evidence that trauma exposure, social support, and coping style significantly contributed to levels of PTSD symptomatology. Maladaptive coping strategies, such as distraction, substance use, venting and self‐blame, accounted for more variance in PTSD symptomatology than adaptive coping strategies, indicating that prevention or treatment interventions may be most effective by targeting reduction of maladaptive coping strategies, with a secondary focus on building adaptive coping strategies.