To Örebro University

Long-term follow-up studies of selective parent training (PT) programs are scarce, particularly in the case of effectiveness trials conducted within regular care settings. This study evaluated the 2-year effects of 4 programs: Comet, Incredible Years, Cope, and Connect and differences in the rate of change among programs were investigated using Latent Growth Modeling (LGM). Participants were parents who had sought help at 30 local service sector units (e.g., child psychiatric clinics and social services centers) for major problems in managing their children's externalizing behavior. Parents of 749 children (63 % boys) with moderate levels of externalizing behavior, aged 3-12, were randomized to one of the 4 PT programs. Assessments included parent-reported measures of child externalizing, hyperactivity and inattention, as well as parenting practices, sense of competence, and parents' stress and depressive symptoms. At 2-year follow-up, there were no differences in any of the child outcomes among the programs. All programs had reduced externalizing behaviors with large effect sizes (d = 1.21 to d = 1.32), and negative parenting practices with moderate to large effect sizes (d = 0.49 to d = 0.83). LGM analyses showed that the 2 behavioral programs, Comet and Incredible Years, produced more rapid reductions in externalizing behavior during the course of the intervention than the non-behavioral program, Connect. Connect, however, was the only program where children continued to improve after the intervention. Overall, the results indicate that the 4 programs were equally effective in a clinical setting, despite differences in their theoretical origin.

Group based preventive parenting programs are efficacious, but seem hard to implement sustainably within regular service. This review aimed to investigate specific challenges related to their implementation. Through a systematic search in several databases, we retrieved 1356 articles for title, abstract, and full-text screening. After screening, we selected 35 articles for quality rating. An established narrative approach allowed us to include 24 studies. We used an ecological approach and a recently suggested implementation construct terminology to report our findings. To date, there are no evaluations of the implementation of group based programs where implementation aspects and effectiveness are compared with other kinds of programs or formats. Hence, important research knowledge is lacking concerning implementation of group based parenting programs. Our finding indicate that certain format specific implementation aspects of group based parenting programs are perceived by practitioners as particularly challenging. For instance, scheduling of group leader workload, provision of additional services (e.g., meals and childcare), and recruitment of participants. Further, practitioners and group leaders influence implementation success and program sustainability as well as parental attitudes and reasons for participation. To highlight the importance of practitioners and parents we suggest adaptations to the ecological model approach. Overall, the theoretical foundation of current implementation research is weak and future implementation research need to be theoretically driven. It is important to fill the existing lack of implementation knowledge because it might be one of the reasons why group based parenting programs have limited impact as preventive interventions on children's mental well-being.

Approximately 10–25% of children and youth suffer from mental health problems, such as depression, emotional difficulties, and disruptive behaviors. The evidence base of the effectiveness of preventive interventions targeting youth mental health currently delivered in regular care is weak. Also, little is known about what is needed for continued delivery of preventive programs in regular care. Hence, there is an evident need of effectiveness evaluations of preventive interventions and their implementation in regular care. In childhood, parenting is an important risk or protective factor for child development, and many programs to improve parents’ parenting has been developed used as preventive interventions. Using an ecological approach to prevention and the prevention research cycle as the theoretical framework this dissertation aim to investigate: 1) the long-term effectiveness of four parenting programs (Cope, Comet, Connect, and the Incredible Years); 2) whether the programs work better for some compared to others; 3) if it matters where parents attend the programs; 4) the field of implementation research regarding group based parenting programs ; and 5) implementation challenges specifically related to such parenting programs. Overall, the long-term results reveal that there are no significant difference in effectiveness across the programs over time. Also, the programs does not seem work better for some compared to others, and neither does it seem as if program effectiveness is much influenced by the sectors delivering the programs (child and adolescent psychiatry, social care, or school). Concerning the implementation of preventive interventions the research base is small, and conclusive evidence concerning implementation aspects of group based parenting programs are non-existing. Thus, it was not possible to draw firm conclusions about their implementation. Nonetheless, existing research clearly suggest that program specific challenges can influence the implementation of group based parenting programs. Implications for practice and research are discussed, for instance, adaptations to the prevention research cycle.