PFSC - Research - Completed

Completed Research

The following projects have been completed by staff and students at the Parenting and Family Support Centre.

All Research

Baby Triple P

In this study we investigated the usefulness of a Baby Triple P, a new version of Triple P designed to prepare couples for a successful transition to parenthood. While most couples receive valuable preparation for their labour and birth experience, most new parents report not feeling confident about parenting and the day to day care of their baby once they take their baby home.

Baby Triple P offers practical ideas and ongoing support for that very daunting “fourth trimester and beyond”. It teaches a variety of skills such as settling babies, helping babies sleep, learning to read babies’ cues and knowing what babies need, learning to promote babies’ development and how to recognise developmental milestones. In addition, it equips new parents with the psychological skills to look after themselves as parents during this exciting time as well as looking after the relationship with their partner.

130 first time parents completed this research project and results from this study will be released shortly.

Chief Investigators: Ms Carmen Spry, Dr Alina Morawska and Professor Matt Sanders
Project Coordinator: Ms Carmen Spry

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Connecting Communities

(funded by Brisbane Southside Division of General Practice)

This project provides a unique opportunity to examine the outcomes achieved by a large scale implementation of three evidence based interventions (Triple P-Positive Parenting Program, Friends and Mental Health First Aid Training) with culturally diverse and Indigenous parents, as well as disadvantaged youth and practitioners workings with families in the southern region of Brisbane. The project builds upon earlier work with the Brisbane South Division of General Practice involving the Every Family project, the first trial in Australia demonstrating positive population level outcomes of a parenting intervention for parents of 4-7 year old children.

The present project builds on and extends this earlier work in several important ways. It makes Triple P more widely available to a more culturally diverse range of families. To ensure the program is appropriately tailored to the needs of parent studies will be conducted examining the acceptability of the parenting intervention and modes of delivery to parent consumers. The project will attempt to build a model of culturally informed evidence based practice in consulting with parents from diverse cultures about children’s social, emotional, and behavioural problems. The findings from the studies of cultural acceptability will be used in the delivery of training of service providers and the implementation of the program with families. The efficacy of Triple P will be assessed by tracking the clinical outcomes achieved by service providers working with families. The project also includes two additional interventions (Friends and Mental Health First Aid) to be implemented concurrently, in the context of a broader framework aiming to connect services and create a sustainable model. These interventions are designed to enhance the capacity of the workforce to assist families from diverse backgrounds, including culturally diverse groups, Indigenous families, and disadvantaged youth.

Chief Investigators: Dr Alina Morawska and Professor Matt Sanders

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The connXionz program is a pastoral care curriculum program for students, which is currently being piloted to students in Grade 8 within Independent schools in Brisbane and surrounding regions. The project aims to reduce the likelihood of adolescents developing negative outcomes, such as academic failure, being bullied, drug and alcohol use, and premature sexual activity, by targeting known risk factors. Risk factors such as engagement within the family and school, negative peer interactions, and poor coping in high risk situations are examined and information provided to assist teenagers to re-engage with important social networks and cope in high risk situations. Collected data is compared to a control group of students to determine the level of impact the program has on the aforementioned risk factors and behaviours. The research trial also involves Teen Triple P seminars to ascertain the added level of impact this component has on the project aims. The usefulness of the program in promoting positive teenager behaviour is being evaluated by Stephanie Shaw, in partial fulfilment of the Doctor of Psychology program requirements.

Chief Investigators: Associate Professor Alan Ralph and Professor Matt Sanders
Project Coordinator: Stephanie Shaw

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Every Family Initiative

(in collaboration with Queensland Divisions of General Practice, funded by beyondblue, Rotary, Telstra, Perpetual Trustees and Macquarie Bank)

The Every Family Initiative is Australia's largest ever population level trial of a comprehensive multi-level parenting strategy designed to reduce the prevalence of common behavioural and emotional problems in young children (4-7 years) and their families. The project seeks to build community capacity and strengthen collaborative relationships and referral pathways for children, their parents and significant others. It involves children, families and communities, as well as school personnel, GPs, other primary health service providers, and mental health services. The project employs a randomised cluster experimental design involving 30 sociodemographically matched catchment areas (10 high-intensity, 10 medium-intensity, and 10 low-intensity intervention communities). High-intensity communities have access to a range of parenting services, including: brief parenting seminars, group parent training programs, regular positive parenting newsletters, parenting tips sheets, telephone counselling support through Parentline, improved capacity of general practitioners to respond to parenting issues, workplace Triple P for teachers, and a coordinated media strategy to promote positive parenting in the community. Medium-intensity communities will receive only some of these services, and low-intensity communities will have minimal exposure to parenting interventions. The main outcome measure is a parenting survey, conducted via Computer Assisted Telephone Interview (CATI), that will be completed by a random cross-section of 4500 parents (1500 from each intervention condition) on two assessment occasions. The first CATI will be conducted with parents of 4-7 year old children in July 2003 and the second CATI with parents of 6-9 year old children in July 2005.

Chief Investigators: Professor Matt Sanders and Dr Sarah Dwyer
Project Coordinators: Associate Professor Alan Ralph and Ms Kerry Bidwell

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Family Transitions Triple P

(funded by the Australian Research Council)

This project was a major step forward in providing an evidence base for interventions with divorced parents in Australia. Family Transitions Triple P- Positive Parenting Program is a theoretically based intervention that addresses the Australian Government's emphasised need of providing families with strategies to resolve relationship disputes and reduce the emotional costs to families experiencing divorce. Once evaluated for effectiveness, the collaboration of this project with Relationships Australia will enable the program to be readily accessible to the divorced parents in Australia.

Chief Investigators: Professor Matt Sanders and Associate Professor Alan Ralph
Project Coordinator: Dr Helen Stallman

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Hassle-free Shopping Discussion Groups


This study examined the efficacy of a brief 2-hour discussion group for parents of preschool children showing disruptive behavior on shopping trips. Forty-six parents with children aged 2 to 6 years were randomly assigned to either the intervention condition or a waitlist control group. Significant intervention effects were found for measures of problem child behavior, dysfunctional parenting styles and parents’ confidence in the parenting role. No group differences were found for parental adjustment or conflict over parenting. Intervention gains were maintained at 6- month follow-up. The findings of this study provide support for the principle of minimal sufficiency. A very brief parenting intervention can have a significant impact on child behavior problems and dysfunctional parenting. The parent discussion group format proves to be a meaningful addition to more intensive levels of Triple P and supports a population level approach that reaches all parents.

Chief Investigators: Ms Sabine Joachim, Professor Matt Sanders and Dr Karen Turner

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Indigenous Group Triple P

(funded by Queensland Health)

This project evaluated the efficacy and general acceptability of Group Triple P tailored for Australian Indigenous families presenting with concerns about their parenting, or their child's behaviour or development. Groups were conducted by Indigenous Health and Child Health workers in community settings. At post-assessment, parents attending Group Triple P reported significantly lower rates of problem child behaviour than those in a waitlist condition on the ECBI Intensity score, with a shift from the clinical range into the non-clinic range on this measure. Parents receiving the intervention also reported significantly lower reliance on dysfunctional parenting practices of authoritarian discipline, displays of anger and irritability (PS Over reactivity scale) than parents in the waitlist condition. By 6-month follow-up, a further significant reduction was found for the PS Laxness scale (particularly permissive discipline) and a trend for reduced Verbosity. This finding points to positive long-term prognosis for the children as there was a change in one of the key risk factors implicated in the maintenance of conduct problem behaviour. No change was found, however, on parental adjustment as parents' mean DASS Depression and Stress scores were not clinically elevated at pre-assessment. The program resulted in high rates of consumer satisfaction, with generally positive comments about the cultural acceptability of the program content, resources and format. Suggestions for change primarily pointed to improving engagement of families, and allowing for more time in group sessions. Families appreciated the efforts made to respect and value their culture and to tailor resources to their community. Intervention gains were maintained at 6-month follow-up, with significant further improvement on parenting style. These results provide support for the efficacy of a culturally tailored approach to Group Triple P as a behavioural family intervention program for Indigenous families, and are some of the first outcomes from a randomised controlled trial of behavioural family intervention for Australian Indigenous families. These outcomes may be seen as a significant step in increasing appropriate service provision for Indigenous families and reducing barriers to accessing available services in the community.

Chief Investigators: Dr Karen Turner and Professor Matt Sanders
Project Coordinator: Sr Mary Richards

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Indigenous Triple P Effectiveness in Community Settings

(funded by National Health and Medical Research Council)

Indigenous families are over-represented in cases of child abuse and neglect (Australian Institute of Health & Welfare, 2002), juvenile conduct disorder, and delinquency (Criminal Justice Commission, 1995). It has become well documented that the long-term impact of the stolen generation has included a break down in traditional parenting skills (NAHSWP, 1989) and a reliance on harsh and coercive parenting practices in the Indigenous community. While research shows that family intervention programs that increase parents' competence in using effective parenting strategies can successfully reduce problem child behaviour, most evidence of program effectiveness is based on the use of these programs in mainstream cultures. For parenting programs to be successful across cultures, they need to be sensitive to the cultural context in which parenting takes place. Following a Queensland Health funded randomised-controlled trial evaluating the efficacy of Group Triple P tailored for Indigenous families, a further effectiveness trial is now under way, evaluating outcomes for Indigenous families accessing Triple P as part of routine service delivery in community settings across Australia.

Chief Investigators: Dr Karen Turner and Professor Matt Sanders

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Lifestyle Triple P

(funded by Telstra Foundation)

Childhood obesity has been described as the next epidemic to affect school-aged children in Australia. There are alarmingly high prevalence rates worldwide (up to 30%), and demonstrable increases in the proportion of overweight children in Australia over the last decade. Weight problems often persist into adulthood, where they become notoriously resistant to treatment and are associated with many diseases (e.g., diabetes, cardiovascular disease, breast cancer, degenerative joint disease). Therefore the development of an effective preventative or early interventions is of paramount importance. The project objectives are to firstly increase knowledge of the role family factors such as parenting play in the development and maintenance of obesity in children and to secondly treat childhood overweight, obesity and associated behavioural and emotional problems by improving family functioning.

Chief Investigators: Professor Matt Sanders and Ms Felicity West
Project Coordinator: Ms Felicity West

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Parenting and Child Sexuality Education

The project was a joint collaboration between the Parenting and Family Support Centre and Family Planning Queensland, aiming to examine parental needs and preferences in relation to sexual education of preschool and early primary school children. The pilot research phase will involve the development of a web survey to assess parenting efficacy, parenting practices, parenting preferences and needs in relation to sexual education for children. The survey will be conducted with parents of 3-10 year old children, and will inform the development of a brief Triple P parenting intervention.

Chief Investigators: Alina Morawska & Matt Sanders
Project Coordinator: Alina Morawska

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Parenting Asthmatic Children

Childhood asthma is a major cause of school absenteeism, child emergency department attendance, and admission to hospital. While effective management strategies are available, parents and children often experience difficulties with adhering to prescribed treatments, increasing asthma morbidity and health system usage. Managing a child’s medication regime can be even more challenging when the child has behavioural problems. Parents play a key role in ensuring asthma medication adherence, however, there is a lack of proven interventions to assist parents with managing their child’s asthma. The purpose of this research was to identify the types of child behaviours and asthma management tasks parents find most problematic, and the modes of intervention that parents desire to assist them in managing their child’s asthma and behaviour. An online survey and an interview study were developed to obtain both quantitative and qualitative data related to this aim. The results of this study will be used to inform the development and trialing of a parenting intervention.

Chief Investigators: Dr Alina Morawska, Dr Scott Burgess, and Ms Caroline Gregory
Project Coordinator: Ms Caroline Gregory

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Parenting Gifted Children

(funded by the Telstra Foundation)

The Every Family Initiative is Australia's largest ever population level trial of a comprehensive multi-level parenting strategy designed to reduce the prevalence of common behavioural and emotional problems in young gifted and talented children. Gifted and talented children have specific educational, social and developmental needs, that are often not well recognised. If a child's ability is not identified and supported, the child may become withdrawn, depressed or exhibit behavioural problems, leading to a loss of potential for both the individual and society as a whole. There is a paucity of research focusing on the needs of gifted children and their families. While there is evidence that gifted children and their parents experience unique challenges, there is a lack of research about the nature and extent of difficulties experienced. Furthermore, there is a lack of empirically supported parenting strategies to help parents in parenting their gifted child.

The research has two main aims:

  1. Provide empirical evidence for the nature and extent of difficulties experienced by gifted children and their parents.
  2. Evaluate an empirically supported parenting strategy to help parents in parenting their gifted child.

The first aim will be addressed by conducting a survey of parents of gifted children, examining the nature and extent of children's behavioural and emotional difficulties, as well as vulnerabilities and risks they face in reaching their potential. The survey will also examine parenting and broader family factors, and aim to establish the relationships between gifted children's difficulties and various risk and protective factors in the child's family environment. A randomised controlled trial of a parenting intervention for parents of gifted children will be evaluated in the second phase of the research, addressing the causes of behavioural and emotional problems among gifted children.

Chief Investigator: Alina Morawska

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Parenting Knowledge

The objectives of this study are firstly to describe parenting knowledge within a general population sample. As the previous research has almost exclusively focused on high-risk groups it will be of value to know if the relationships consistently found between parenting knowledge and demographic variables in these samples can also be found within the broader population of parents. Further, the literature will be extended by examining how these relationships might differ depending upon the type of parental knowledge assessed. Secondly, this study aims to clarify the possible direct relationship between parenting knowledge and problematic child behaviour as very few studies to date have examined this relationship. Particular focus will be on understanding how the relationship might differ as a function of type of parenting knowledge assessed. The study also aims to further understand the relationships between parenting knowledge, parenting competence and parenting self-efficacy (PSE).

Chief Investigators: Ms Leanne Winter and Dr Alina Morawska

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Pathways Triple P

(funded by National Council for the Prevention of Child Abuse, Department of Housing, Queensland Health and Criminology Research Council)

Child abuse and neglect is a significant social problem in Australia. Unfortunately, there is limited research in this area and, of the intervention programs available, most have not been subject to rigorous evaluation. This project developed and evaluated a comprehensive multimodal model of behavioural family intervention to address the specific needs of parents notified by authorities for child abuse and neglect. This enhanced program is tailored to meet the needs of individual families and address the risk factors commonly encountered in working with abusive parents (e.g. problem solving and coping skills training, anger management, challenging dysfunctional developmental expectations and attributions). A randomised controlled trial compared an enhanced behavioural family intervention (Enhanced Triple P plus Pathways Module) with Standard Triple P parent training. Ninety-eight parents experiencing significant difficulties in managing their own anger in their interactions with their preschool-aged children were randomly assigned either an enhanced group-administered behavioral family intervention program based on the Triple P-Positive Parenting Program that incorporated attributional retraining and anger management (EBFI) or a standard behavioral family intervention program (SBFI) which provided training in parenting skills alone. At post-intervention, both conditions were associated with lower levels of observed and parent-reported disruptive child behavior, lower levels of parent-reported dysfunctional parenting, greater parental self-efficacy, less parental distress, relationship conflict and similarly high levels of consumer satisfaction. EBFI showed a significantly greater short-term improvement on measures of negative parental attributions for children's misbehaviour, potential for child abuse and unrealistic parental expectations than SBFI. At 6-month follow-up both conditions showed similarly positive outcomes on all measures of child abuse potential, parent practices, parental adjustment and child behavior and adjustment, however EBFI continued to show greater change in negative parental attributions.

Chief Investigators: Professor Matt Sanders, Mr Fred Gravestock and Ms Aileen Pidgeon
Project Coordinators: Ms Samantha Brown, Mr Mark Connors

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Pathways Triple P and Parent-Child Relationships


A large body of research has emphasized the importance of parent-child relationship quality including attachment security for promoting positive child development in the long-term. Although Triple P incorporates strategies for promoting positive parent-child relationships, research has not specifically assessed this outcome. The current project is an efficacy study evaluating whether Pathways Triple P improves the quality of parent-child relationships for families identifying problems in this area. In addition to strategies for improving parent-child relationships, Pathways Triple P specifically targets parent emotional regulation and parent attributions of child behaviour in the context of intergenerational influences on parent-child relations.

Chief Investigators: Associate Professor Kate Sofronoff and Ms Tamera Wiggins

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Positive Parenting for Healthy Living

Every day thousands of Australian children suffer the effects of asthma and eczema, and families struggle with illness management and children’s behavioural and emotional adjustment.

Positive Parenting for Healthy Living is an adaptation of the successful Triple P - Positive Parenting Program, offering practical ideas and support for parents of children suffering asthma or eczema. This innovative group program is designed to help parents manage their child’s illness, assist children in coping with their illness and emotions, and prevent and manage difficult child behaviour.

Chief Investigators: Dr Alina Morawska and Dr Amy Mitchell
Project Coordinator: Dr Amy Mitchell

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Positive Parenting of Preschoolers Trial

(funded by National Health and Medical Research Council and Queensland Health)

This trial aimed to compare three variants of behavioural family intervention from the Triple P system. Participants were 305 families with a 3-year-old child at high risk for developing conduct problems. Families were randomly assigned to one of four groups: Standard Triple P, Self-directed Triple P, Enhanced Triple P, or a waitlist. The Enhanced program produced the most consistent short-term effects followed by the Standard and Self-directed programs across observational and parent-report measures of child behaviour, parenting practices and parents' sense of competence. The two therapist-assisted programs showed improvements in mothers' use of praise following intervention whereas all four conditions showed decreases in parent negative behaviour at post-intervention. In addition, mothers and fathers receiving Enhanced Triple P reported less use of dysfunctional discipline practices, more satisfaction and efficacy in their parenting role, and less use of physical aggression toward their child following intervention. While mothers in the Standard condition reported similar changes in discipline practices and parenting competence, there was no decrease in fathers' reports of physical aggression toward their child. Although mothers in Self-directed Triple P reported more satisfaction with parenting, their reported use of dysfunctional discipline practices and physical aggression did not change following intervention. By 1-year follow-up, children in all three program variants had achieved similar levels of clinically reliable change in their observed disruptive behaviour. Approximately two thirds of the intervention children showed clinically significant reductions in observed and parent-reported levels of negative child behaviour at follow-up. Each of the interventions also resulted in significant improvements across observational and parent-report measures of parenting style, competence, and aggression to child as well as decreases in mothers' reports of depression, anxiety and stress from pre-intervention to follow-up. These findings add to the growing evidence that different variants of behavioural family intervention can be clinically viable and highly acceptable interventions, effective in reducing disruptive behaviour in young children with early onset behaviour problems. The results suggest that high risk children from disadvantaged families, initially should be offered a standard parent training program and if there is no improvement in child behaviour or on measures of parental or family distress, adjunctive interventions should be considered. Enhanced interventions should target only the specific risk factors causing ongoing concern.

Chief Investigators: Professor Matt Sanders and Dr William Bor
Project Coordinator: Ms Carol Markie-Dadds

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Postnatal Wellbeing Program

(funded by Financial Markets for Children and The University of Queensland)

To date programs for post-natal depression have focused on treating the depressed individual, however, this approach is limited as it neglects difficulties with spouse and parent-infant relations. Interpersonal relationships within the family affect the onset, maintenance and resolution of depression. This project investigated the efficacy of a cognitive behavioural family intervention for postnatal depression that involved integrating effective psychological treatment for postnatal depression with couples therapy and parent training. The program was evaluated using a randomised group comparison design (intervention vs usual care in the community). The intervention successfully reduced maternal depression, anxiety and stress, and increased parenting efficacy by post-assessment. These results maintained at 6-month follow-up, with delayed effects for improved marital satisfaction and family functioning.

Chief Investigators: Professor Matt Sanders and Ms Justine Burns
Project Coordinator: Ms Justine Burns

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Primary Care Stepping Stones Triple P


This project evaluated a primary care version of Stepping Stones Triple P with parent of children with Autism Spectrum Disorder (ASD). Primary Care Stepping Stones Triple P is designed to be delivered in 4 brief sessions to parents of children with a disability who are also presenting with specific concerns about their child’s behaviour or development. Sixty-four parents of children with ASD aged 2 to 9 years took part in a randomised controlled trial. Relative to the care-as-usual group, significant short-term improvements were found in the intervention group on parent-reported child behavior problems, dysfunctional parenting styles, parenting confidence, and parental stress, parental conflict and relationship happiness. Short-term effects were predominantly maintained at six-month follow-up and parents reported high levels of goal achievement and satisfaction with the program. The results indicate that a brief low intensity version of Stepping Stones Triple P is an efficacious intervention for parents of children with ASD.

Chief Investigators: Dr Cassie Tellegen, Professor Matt Sanders, and Associate Professsor Kate Sofronoff
Project Coordinator: Dr Cassie Tellegen

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Primary Care Triple P Effectiveness and Dissemination

(in collaboration with Queensland Health)

Medical professionals are often the first point of contact for parents of children with behaviour problems. General practitioners (GPs) and child health nurses are well positioned in the community to provide parenting support, yet primary care settings are often under utilised for the provision of effective mental health programs for children and families. Evaluation of brief consultation models is therefore essential to enable practitioners to respond more effectively to parents' concerns. Two recent studies assessed the impact of Primary Care Triple P, a brief behavioural family intervention program for families of children at risk of developing behavioural problems, and evaluated dissemination outcomes. The first study evaluated the effects of Primary Care Triple P for parents of pre-school aged children delivered by child health nurses in a primary care setting. Compared to parents in a waitlist control condition, parents receiving Primary Care Triple P reported significantly lower levels of disruptive child behavior, dysfunctional parenting, and reduced anxiety and stress in comparison to controls. These short-term effects were largely maintained at 6-month follow-up. The second study examined factors affecting the implementation of Primary Care Triple P in the work setting. Primary care practitioners who participated in Triple P training (N=519) were surveyed pre and post-training and at 6 month follow-up, to assess the impact of prior experience, self-efficacy, program characteristics, satisfaction with training, workplace supports and workplace barriers on reported use of Triple P. The majority of practitioners (97%) reported using Triple P, with a quarter of clients provided the full 3-4 session program. Practitioner self-efficacy and workplace supports predicted implementation of Triple P, while the impact of program characteristics on implementation was mediated by self-efficacy. Prior professional experience and satisfaction with training did not predict self-efficacy or uptake. These results highlight the importance of the post-training environment for facilitating the implementation of evidence-based programs in primary care settings.

Chief Investigators: Dr Karen Turner and Professor Matt Sanders
Project Coordinator: Dr Karen Turner

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Primary Care Triple P for Noncompliance in Young Children

The project aims to evaluate the effects of a brief version of Primary Care Triple P to parents in a group setting. Parents who have difficulties with disobedience of their children can take part in a group session which will teach them strategies to deal with temper tantrums and disobedience. Parents will be taught the disobedience management strategies. During the training sessions participants will be shown a videotape demonstrating procedures and will be provided with a Triple P Tipsheet. There will be time to practise skills and parents can benefit from discussing parenting plans with other parents in the group. Participants will be asked to complete questionnaires about the behaviour of their child, about their parenting style and about how confident and happy they are about being a parent. Questionnaires will be completed prior to and 5 weeks after the group sessions to determine the extent to which changes or improvements have occurred. The aim of the intervention is to provide parents with a parenting plan based on planned activities training (PAT). PAT involves providing children with engaging activities, discussion of rules in advance, advanced selection of consequences for both prosocial and disruptive or oppositional behaviours. Most likely the parents will learn how to use these strategies in other situations as well, which may improve parenting and child behaviour in general.

Chief Investigators: Dr Alina Morawska and Professor Matt Sanders

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Primary Care Triple P in General Practice

(in collaboration with Brisbane Southside Central Division of General Practice)

General medical practitioners (GPs) were assigned to Primary Care Triple P training or to a waitlist control condition. The training consisted of pre-training reading materials, mini lectures, video and live demonstration and role playing of core consultation skills, feedback, clinical problem solving exercises and competency checks. The results from a practice audit of successive paediatric consultations prior to and following training showed that GPs who had participated in the training showed significantly greater use of targeted parent consultation skills, and greater satisfaction with the outcomes of their parent consultations, than GPs in the waitlist comparison group. Observations of practitioner consultation skills during simulated patient interviews with parents showed there was a significant overall improvement in doctors' interactional skills during parent consultations. There was a high overall level of satisfaction with the quality of training received by the GPs involved.

Chief Investigators: Professor Matt Sanders, Dr Karen Turner, Dr Chris McAuliffe and Dr Clare Maher
Project Coordinator: Ms Lucy Tully

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Reducing Care-Giver Burden

(funded by Australian Research Council and Apex Foundation for Research into Intellectual Disabilities)

Research indicates that parents of disabled children are at increased risk for greater levels of stress than are parents of non-disabled children. This stress often leads to family dysfunction and marital breakdown. Child behaviour problems and parental care-giving are identified as major contributors to the stress that families experience. However, there is an absence of studies that systematically address these issues. This study aimed to enhance knowledge in this area by developing, implementing and evaluating an intervention program aimed at reducing child problem behaviour and alleviating stress related to the care-giving role. This study compared two variants of a behavioural parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities and problem behaviour. Families were randomly allocated to an enhanced adjunctive intervention (SSTP-E), standard intervention (SSTP-S) or waitlist control (WL) condition. At postintervention, both programs were associated with significantly lower levels of observed negative child behaviour, significant reductions in the umber of care-giving settings where children displayed problem behaviour, and significantly improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. The SSTP-E condition was also associated with significant reductions in parents' report of child problem behaviour during care-giving, and the SSTP-S condition resulted in significant reductions in overall disruptive child behaviour and improvements in parenting skills. Gains attained at postintervention were maintained at 1-year follow-up. There was partial evidence at postintervention and 1 year follow-up to suggest that the enhanced intervention resulted in better outcomes than the standard intervention. Specifically, this related to lower levels of difficult child behaviour during care-giving at postintervention, and lower rates of overall child disruptive behaviour at 1-year follow-up. Both interventions produced significant reductions in child problem behaviour, with 67% of children in the SSTP-E and 77% of children in the SSTP-S showing clinically reliable change in a positive direction from preintervention to follow-up. Parents reported a high level of satisfaction with both interventions.

Chief Investigators: Ms Karen Plant and Professor Matt Sanders
Project Coordinator: Ms Karen Plant

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Self-Directed Triple P

(funded by Australian Rotary Health Research Fund)

Two variants of a self-directed behavioural family intervention (Teen Triple P) were compared with 51 families with a teen in Year 7 or 8, who reported experiencing difficulties with their adolescents. Families were randomly assigned to either Standard Self-Directed Teen Triple P, a 10-module workbook program supplemented by a video; Enhanced Self-directed Teen Triple P, the standard program with the addition of 10, 15-minute weekly telephone consultations; or a waitlist control group. At post-intervention, using parent report measures of adolescent behaviour and parenting practices, parents in the enhanced condition reported significantly fewer adolescent behavioural problems and less use of dysfunctional parenting strategies than parents in either the standard or waitlist conditions. Improvements were maintained at 3-month follow-up. There was no significant difference among conditions at post-intervention or follow-up on parents' self-report measures of depression, anxiety, stress or relationship quality. This research demonstrates that a self-directed behavioural family intervention with minimal therapist contact is an effective intervention for adolescent behavioural and emotional problems. It has implications for providing minimally sufficient interventions for parents and making interventions more accessible for families in rural or remote locations or those who have difficulty accessing traditional services.

Chief Investigators: Associate Professor Alan Ralph and Professor Matt Sanders
Project Coordinator: Dr Helen Stallman

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Self-Directed Triple P

(funded by National Health and Medical Research Council)

A self-directed program that combines telephone contact and written information can be easily accessed in the rural population, but maintains anonymity and makes few demands in terms of travel, time and finance. This study evaluated the effects of Self-Directed Triple P enhanced by telephone consultations, using a randomised control group methodology. Reading material was augmented by regular telephone contact that cues, prompts and reinforces the parents' use of the self-regulation model. Parents were encouraged to identify individual action that they could take to produce change. Mothers in the intervention group reported significantly lower levels of disruptive child behaviour, lower levels of dysfunctional parenting practices and higher levels of parental adjustment as compared to the mothers in the control group, at post treatment. These findings were maintained at 3-month follow-up.

Chief Investigators: Ms Carol Markie-Dadds and Professor Matt Sanders
Project Coordinator: Sheryl Connell

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Stepping Stones for Autism

(funded by the Australian Rotary Health Research Fund)

It is widely recognised that children with disabilities are at greater risk of developing significant behavioural and emotional problems. The Stepping Stones Triple P- Positive Parenting Program aims to assist parents of children with a disability develop practical solutions for common and potentially stressful behavioural and developmental challenges. Stepping Stones Triple P, an adaptation of the Triple P multilevel family intervention program for the prevention and treatment of behavioural and emotional problems in preadolescent children, is the first evidence-based program of its kind in the world. It is designed to strengthen families' capacity to support a child with a disability, develop practical solutions for common and potentially stressful behavioural and developmental challenges, and help contribute to a balanced, meaningful and fulfilling life at home and in the community. This project will evaluate Stepping Stones Triple P with parents of children aged 2-9 years who have been diagnosed with Autism Spectrum Disorder, Down syndrome and cerebral palsy. The program involves six group sessions and three individual sessions conducted over the phone. Results of initial trials indicate a significant reduction in challenging behaviours, parental stress, depression and anxiety as well as increased parental confidence and competence and marital satisfaction.

Chief Investigators: Professor Matt Sanders, Dr Kate Sofronoff and Dr Jeanie Sheffield
Project Coordinators: Dr Kate Sofronoff and Ms Gemma Reveleigh

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Stepping Stones Triple P for Parents of Children with Traumatic Brain Injury

Acquired brain injury (or ABI) is one of the leading causes of hospitalisation, disability, and death worldwide. In children, brain injury can cause existing skills and abilities to be lost at least temporarily, and can also cause delays in the development of new skills. Some children recover very well, however it is common for children to experience some form of behavioural, social, academic, physical, or emotional problems. As well as significantly impacting the child’s well being and development, paediatric brain injury also affects the entire family system. Despite the far-reaching consequences of paediatric acquired brain injury, there is currently limited research into appropriate parenting and family support options for this population.

The initial aim of this project was to explore the unique experiences, challenges, and needs of families with a child who has sustained an acquired brain injury through focus groups. A randomised controlled trial is now being conducted to assess the efficacy of the Group Stepping Stones Triple P program for these families, tailored to meet their specific needs. We are also interested in whether a stress management intervention, based in Acceptance and Commitment Therapy, can provide additional therapeutic benefit in terms of parent and child outcomes.

Chief Investigators: Ms Felicity Brown and Associate Professor Kate Sofronoff
Project Coordinator: Ms Felicity Brown

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Stepping Stones Triple P

(in collaboration with Western Australia's Disability Services Commission and Curtin University, funded by Healthway Health Promotion Research and Intellectual Disabilities Commission)

Stepping Stones was a collaborative project between Western Australia's Disability Services Commission, Curtin University's School of Psychology, and the Parenting and Family Support Centre at The University of Queensland. The overall objective was to develop, implement and evaluate the impact of an intensive early intervention program that specifically targets families of preschool children with disabilities, who are perceived to be at risk of developing problems such as conduct disorder, because of elevated levels of challenging behaviour (e.g. disruptive, aggressive, and antisocial behaviour towards property and persons, and self-injurious behaviours). Standard and Enhanced Triple P were modified for use with children with disabilities. Training in skills to enhance parents' adjustment to having a child with a disability was also offered. A randomised waitlist control design was used and intervention was provided by a clinical psychologist and a developmental psychologist employed by Disability Services Commission. Stepping Stones Triple P was associated with lower levels of child behavior problems reported by mothers and independent observers compared to control group children, at post-intervention. Effects were maintained at a 6-month follow-up. Improvements were found in maternal and paternal parenting style, and maternal stress in the intervention group, with maintenance at follow-up.

Chief Investigators: Professor Matt Sanders and Trevor Mazzucchelli
Project Coordinator: Lisa Studman

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Surviving Multiples

An increasing number of families are facing the unique challenge of parenting twins and triplets, yet there are few specific services available for them. Emerging research indicates that parents of multiples are at greater risk of experiencing parenting stress and displaying compromised parenting practices, while the children themselves maybe at increased risk of emotional and behavioural problems. The primary aim of the present study was to evaluate the efficacy of a tailored Group Triple P – Positive Parenting Program for parents of twins and triplets aged between 18 months and 6 years. The present study was the first randomised controlled evaluation of a behavioural parenting skills program with parents of multiples. Sixty-seven parents of multiples were randomly assigned to either Surviving Multiples Group Triple P (SMGTP) (N=35) or a waitlist control condition (N=32). There were significant effects of intervention demonstrated at post intervention and six months follow-up for parent reports of child behaviour, parenting style, strategy use, global and specific parenting confidence, parenting satisfaction, and parental stress. Parents in the intervention condition when compared to the control condition, showed not only statistically significant improvements, but the changes were also reliable. Parents in the intervention condition also demonstrated significant shifts into the normative range from the clinical range on a number of measures. While the majority of hypotheses were supported, parent perception of social support did not change across conditions. This study demonstrates that a tailored behavioural parenting group is effective and highly acceptable for parents of young multiples which could be offered to families to address the current lack of multiples-specific parenting services available in the community.

Chief Investigators: Dr Samantha Brown, Professor Matt Sanders
Project Coordinators: Dr Samantha Brown

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Teachers as Parents

(funded by the Australian Rotary Health Research Fund and the Australian Research Council)

The Teachers as Parents project is investigating how to assist working parents better balance the competing demands of work and family life. The project assesses the efficacy of a version of Workplace Triple P that has been specifically tailored to the needs of teachers. All eligible teachers in the Brisbane area with children under 12 will be offered free participation in Work Place Triple P for teachers as a part of the trial. It is hypothesized that compared teachers in the control condition teachers who participate in Workplace Triple P will report lower levels of family and work stress, be better able to balance work and family commitments. Moreover, it is expected that the level of disruptive classroom behaviour will be lower in the classes of teachers who have completed Workplace Triple P.

Chief Investigators: Ms Divna Haslam and Professor Matt Sanders
Project Coordinator: Ms Divna Haslam

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Testimonials and Participation in Triple P

Positive Parenting Program impacts on their perceptions of the acceptability and usefulness of Triple P – Positive Parenting Program, their memory of the parenting intervention and their intentions to participate in the program; (2) to examine the qualities of a testimonial which enhance parental engagement in parenting intervention. Parents will complete questionnaires assessing their socio-demographic characteristics, their parenting and their child’s behaviour. Following this they will view a short segment of the a Triple P DVD explaining the five principles of positive parenting. Before they watch the segment of Triple P parents will also see one of a number of testimonials supporting the program. Parents will be randomly allocated to one specific testimonial, which could be delivered by different people, with varying characteristics e.g., same or different gender, expert vs community leader, etc. Participants will complete a questionnaire assessing how useful, and acceptable they find Triple P, and how likely they would be to use or participate in the program. Participants will also have the opportunity to access additional DVD material after the study completion, and this will also serve as a means of testing how effective testimonials are in engaging parents with a parenting program.

Chief Investigators: Dr Alina Morawska and Professor Matt Sanders

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The Effectiveness and Acceptability of Triple P with Japanese Parents

(Supported by Queensland Program Japanese Language Education 2004, Parenting Network in Saitama Prefecture Japan, and the National Institute of Public Health)

Although Triple P has been implemented in non-Western societies such as Hong Kong and Singapore, the programs have been widely evaluated in Western societies such as Australia and the United Kingdom. Culture plays a major role in shaping the ecology of parenting. Cultural factors relate to parenting beliefs and practices. The aim of this project is the cultural validation of Triple P with examination of effectiveness and identification of variables associated with parental acceptability. The research series includes a pilot study with Japanese parents living in Brisbane (Study I), an effectiveness study with Japanese parents in the Tokyo area (Study II), and a cultural validation study with Japanese parents in Japan (Study III). The findings in Study I and II with Group Triple P revealed significant program and maintenance effects on child behaviour problems, parental practices and parental competence. Participants showed considerable satisfaction with the program and supported the usefulness of positive parenting strategies in the Japanese context. Further analyses and examinations are underway.

Chief Investigators: Dr Kate Sofronoff, Ms Yuki Matsumoto and Professor Matt Sanders
Project Coordinator: Ms Yuki Matsumoto

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Toddler Triple P

(in collaboration with Parentline, funded by Kids Helpline)

Parents often find toddlerhood a particularly challenging time with sources of concern including disobedience, aggression, tantrums, problems at mealtime, toilet training and with sleep routines. By establishing firm understandings and routines, as well as adopting a calm, consistent approach, parents can minimise the frustrations and hazards of toddlerhood for their children and for themselves. Furthermore, they can enhance their toddler's development and help prevent any future behavioural problems or difficulties. The PFSC, in collaboration with Parentline, has conducted two research trials designed to assess how well a telephone assisted self-help version of Triple P can work for parents of toddlers. The partnership between the Centre and Parentline was designed to evaluate and bring to parents a parenting resource which can help them deal with the challenges presented by toddlers.

The results of a randomised controlled trial conducted at the PFSC indicated that while a self-directed version of Triple P was effective in improving both child and family outcomes, these effects were more clinically significant with the addition of minimal clinician support. Parents who were supported by weekly telephone consultations in working through the program, reported greater improvements in their toddler's behaviour, as well as in their own parenting behaviour and parenting confidence.

Parentline counsellors trained in the delivery of Triple P over the phone, participated in a second research trial to determine how effectively the program could be delivered to parents. The findings of the trial indicated that Triple P could be readily implemented by Parentline counsellors, within a regular service delivery context, and parents benefited from their participation. Parents reported significant improvements in their toddler's behaviour, their own parenting behaviour and confidence, as well as reductions in levels of stress and conflict between parents.

Many parents have difficulties accessing services or live in remote areas where services are very limited. The findings of this collaborative research has provided important information about the effectiveness of self-directed Triple P. Parents who might otherwise be unable to access an evidence-based parenting intervention, now have the opportunity to complete self-directed Triple P, and they can be supported by Parentline staff in working through the program.

Chief Investigators: Dr Alina Morawska and Professor Matt Sanders
Project Coordinator: Dr Alina Morawska

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Transition to High School Project

(funded by Australian Department of Health and Ageing National Suicide Prevention Strategy)

Group Teen Triple P is a brief group parenting program for parents of teenagers with a particular focus on helping parents manage the transition from late childhood to early adolescence. It aims to enhance the quality of parent-child relations and reduce behavioural problems of adolescents by increasing social competence, enhancing self-esteem, and reducing disruptive, aggressive, and oppositional behaviour. The Transition to High School Project targeted families with pre-adolescent children in high need areas who were making the transition to high school, and provided an information campaign, psychoeducational group sessions, and enhanced program for families requiring more assistance. The project aimed to normalise the parenthood preparation process for transition of children to the teenage years, and encourage indigenous families to participate in parenting/adolescent support. The goals of the project were to implement and evaluate a community-based positive parenting program that provides an intervention to match the intensity of families' needs by enhancing protective factors associated with youth suicide and reducing specific family risk factors by increasing parental use of positive parenting strategies, sense of self-efficacy in parenting, and parent support for school behaviour management policies as well as reducing the use of coercive parenting methods, parental depression and the level of marital conflict over parenting. Group Teen Triple P was offered to all parents of students entering their first year of high school at age 12 in several high schools in northern metropolitan Brisbane over a 3-year period. The group programs were delivered predominantly by school-based staff who had received minimal training. Family access to parenting/adolescent support was also enhanced and links forged between community agencies and families.Following participation in the group program, parents reported significant improvements in teenager functioning, parent-teenager conflict, and parenting style with effect sizes in the moderate to large range. Parents also reported significant reductions in disagreements over parenting, and in parental stress and depression, with moderate to small effect sizes.

Chief Investigators: Associate Professor Alan Ralph and Professor Matt Sanders
Project Coordinator: Mr Santo Russo

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Transition to School Project

(in collaboration with Education Queensland)

Although Triple P has been shown to be extremely effective in reducing the number and intensity of child behaviour problems in the home, evidence to support the generalisation of this improved child behaviour to the classroom has been scant. The Transition to School Project aimed to provide a community-based intervention through which schools aimed to improve the at-home and in-class behaviour of children via parent education. Twenty five Brisbane State schools participated in the project. These schools were paired on the basis of demographics and geographic regions and then randomly allocated to either an intervention or waitlist control condition. The program was targeted at all parents of children making the transition from preschool into Grade 1. Parents in the intervention group were provided with an extensive information campaign on Triple P and general parenting issues. This information campaign aimed to increase knowledge about parenting and decrease the stigma associated with parent training, therefore increasing participation in groups. Parents were then invited to attend Group Triple P. A unique feature of the Transition to School Project was that existing Education Department resources were utilised in the running of the program. In this way, schools had their own staff trained in the provision of Triple P, increasing their ownership of the program, increasing cost effectiveness and enhancing the links between the school and community. Compared to control schools, parents in the intervention schools showed a significantly greater reduction in targeted risk factors, particularly dysfunctional parenting style. Following the parenting intervention, the levels of teacher reported conduct problems were also significantly lower in the intervention classrooms than in the control classrooms. A second aim of the project was to investigate the factors that mediate and moderate the effectiveness of Triple P. The results showed that the impact of the parent training intervention on dysfunctional parenting style was moderated by the child's gender, family income, pre-intervention levels of parental satisfaction in the parenting role and parental stress, and partially mediated by changes in parental satisfaction and efficacy. Further, it was found that the impact of the parent training intervention on children's behaviour problems was partially mediated by dysfunctional parenting style, parental sense of competence and stress, and was moderated to a small degree by family type.

Chief Investigators: Dr Philippa McTaggart and Professor Matt Sanders
Project Coordinator: Dr Philippa McTaggart

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Triple P and the Media

(funded by National Health and Medical Research Council)

In recent times there has been a proliferation of "infotainment" programs on our TV networks. A recent addition to this genre was the Families television series, produced by MDB Entertainment in conjunction with Triple P. Families provides parents with information on parenting skills and a broad range of family issues such as how to encourage desirable behaviour in children and how to manage common difficulties. The series, aired on commercial television in New Zealand, includes 12 half hour programs each containing a 5-minute Triple P segment. Each week's Triple P segment was accompanied by a parent tip sheet provided free of charge to families who called a toll free number. Although popular, it is not known whether this type of program can bring about behaviour change in viewers. This randomised controlled study evaluated the impact of the television series, in the format of 12 videos and tip sheets. Intervention group parents watched two episodes of the series (in their own home) each week, at a time convenient to them, and read the relevant tip sheets. In comparison to a waitlist control group, mothers in the TV condition reported significant reductions in child behaviour problems post-treatment. There was a significant decrease in the percentage of children from the TV condition who fell in the clinical range - from 46% prior to the intervention (over twice the national average) to 14% remaining in the clinical range following the intervention. Mothers in the TV condition also reported an increased sense of competence and satisfaction in their parenting abilities relative to mothers in the control group. Although the upfront costs of establishing a media program such as Families is substantial, the reach may be wide and the long-term benefits to individuals and the community may outweigh these initial costs.

Chief Investigator: Professor Matt Sanders
Project Coordinators: Ms Danielle Montgomery and Ms Melinda Wilson

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Triple P for Children with Mealtime Problems

Child feeding difficulties are very common and cause significant distress for children and parents, however, there is limited data available on the factors which contribute to problems, and very few interventions have been examined to assist families. The project will aim to (a) investigate the factors associated with mealtime difficulties of toddlers/preschoolers and families with and without feeding difficulties (Study 1), and (b) test the efficacy of a group-based behavioural parent training program with parents of children with feeding difficulties (Study 2). The development of an effective intervention for parents of young children with feeding difficulties would be an extremely valuable addition to clinical practice, given the absence of such a program, the commonality of feeding difficulties, and the consequences for both the child and family.

Parents in Study 1 will be include those who may or may not have difficulties with their child’s mealtime, and will complete a set of questionnaires and may also be observed during a mealtime. Parents without feeding difficulties who volunteer to participate will receive an incentive (e.g. attendance at a Triple P seminar, movie/food voucher), and general written feedback on their ratings on the various measures. Parents with feeding difficulties will be offered intervention, which previous case study and preliminary research would suggest is effective in reducing feeding concerns. This intervention will be evaluated in Study 2 of this project using a randomised controlled trial methodology.

Chief Investigators: Ms Michelle Adamson and Dr Alina Morawska

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Triple P for Grandparents

Grandparents are an important component of the family unit, and with changing demographic trends reflecting an increase in dual earner households, and the demand on child care services constantly increasing, the role that grandparents play within the family unit has increased significantly. Reflective of these trends, grandparents are now the biggest single providers of child care between birth and 12 years of age in Australia (ABS, 2006). Despite these developments there is still very little known on how grandparents cope with this newly found role, what challenges they are presented with, and if necessary what is the most effective way to intervene.

The aim of the Triple P for Grandparents Project is to explore the nature and demands of modern day grandparenting and develop a program specifically for grandparents to help assist them in their important role of being care providers. Once the program is developed it will be evaluated by a randomised control trial to examine the effectiveness of the program at assisting both the grandparents, grandchildren and family functioning.

Chief Investigators: Mr James Kirby and Professor Matthew Sanders
Project Coordinator: Mr James Kirby

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Triple P for Indonesian Parents

Dissemination of evidence-based parenting programs is mostly conducted in western countries and only a few studies have reported the effectiveness of an evidence-based parenting program in Asian countries. As a developing country in Asia that has the fourth largest population in the world, Indonesia currently has no evidence-based parenting program. Our survey with 273 Indonesian parents residing in Indonesia and Australia recently found that parents used ineffective discipline strategies with their child, such as making the child apologise for his or her misbehaviour, giving the child a lecture, and shouting at their child when the child misbehaved. Parents were not familiar with existing parenting programs but indicated an interest in participating in a parenting program if one were available in the future.

The aim of this project was to investigate the acceptability and efficacy of the Triple P seminar series with Indonesian parents in Australia (pilot trial) and in Indonesia (randomized controlled trial). The overall findings showed that the program was highly acceptable and efficacious in reducing child emotional and behavioural problems and improving parenting competence.

Chief investigator: Agnes Sumargi, Associate Professor Kate Sofronoff, Dr Alina Morawska
Project coordinator: Agnes Sumargi

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Workplace Triple P

(funded by Australian Research Council and Department of Industrial Relations)

Workplace Triple P is a collaborative project between The Queensland Department of Industrial Relations and the Parenting and Family Support Centre at The University of Queensland. There are two primary objectives of the project. The first is to develop and evaluate a measure of workplace "family friendliness" that can be utilised by organisations as an assessment tool. Secondly, the project aims to develop, implement and evaluate the effectiveness of a group behavioural family intervention for working parents. The program targets families of preschool, middle school, and high school, who have one or more working parents and are having difficulties balancing the two demands effectively.

Chief Investigator: Professor Matt Sanders
Project Coordinator: Dr Helen Stallman

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