Aim
The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).

Method
This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health.

Results
Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).

Interpretation
Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

/pdf/a-systematic-review-of-interventions-for-children-with-52c90cna9r.pdf

A systematic review of interventions for children with cerebral palsy: state of the evidence.

https://espace.library.uq.edu.au/view/UQ:331769/UQ331769OA.pdf

The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support

A meta-analysis encompassing all studies evaluating the impact of the Triple P-Positive Parenting Program on parent and child outcome measures was conducted in an effort to identify variables that moderate the program’s effectiveness. Hierarchical linear models (HLM) with three levels of data were employed to analyze effect sizes. The results (N = 55 studies) indicate that Triple P causes positive changes in parenting skills, child problem behavior and parental well-being in the small to moderate range, varying as a function of the intensity of the intervention. The most salient findings of variables moderating the interventions’ impact were larger effects found on parent report as compared to observational measures and more improvement associated with more intensive formats and initially more distressed families. Sample characteristics (e.g., child’s age, being a boy) and methodological features (e.g., study quality) exhibited different degrees of predictive power. The analysis clearly identified several strengths of the Triple P system, most importantly its ability to effect meaningful improvement in parents and children. Some limitations pertain to the small evidence-base of certain formats of Triple P and the lack of follow-up data beyond 3 years after the intervention. Many of the present findings may be relevant to other evidence-based parenting programs.

A Comprehensive Meta-Analysis of Triple P-Positive Parenting Program Using Hierarchical Linear Modeling: Effectiveness and Moderating Variables

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed.

/pdf/triple-p-positive-parenting-program-as-a-public-health-3uj27wv3kj.pdf

Triple P-Positive Parenting Program as a Public Health Approach to Strengthening Parenting

The quality of parenting children receive has a major influence on their development, well-being, and life opportunities. Of all the potentially modifiable influences that can be targeted through preventive interventions, none are more important than the quality of parenting children experience. Prevention interventions targeting parenting should be widely used to promote positive developmental outcomes for children and adolescents. This review argues that the development of comprehensive evidence-based strategies to improve the quality of parenting is best viewed as a major public health challenge. Using the Triple P-Positive Parenting Program as an exemplar, the initial development, gradual transformation into a public health model, and then global dissemination of the approach is described. The assumptions underpinning the public health approach to parenting support are discussed, along with key criteria that need to be met for the approach to work. Factors that facilitate and impede the global implementation and dissemination of evidence-based parenting programs are considered along with implications for future research, policy, and practice.

/pdf/development-evaluation-and-multinational-dissemination-of-1zwhpk4w54.pdf

Development, Evaluation, and Multinational Dissemination of the Triple P-Positive Parenting Program

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.

/pdf/behavioral-family-intervention-for-children-with-2ty3361b4j.pdf

Behavioral Family Intervention for Children With Developmental Disabilities and Behavioral Problems

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.

/pdf/stepping-stones-triple-p-the-theoretical-basis-and-3r63qe9rzo.pdf

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.

Lisa J. Studman

Papers

Behavioral Family Intervention for Children With Developmental Disabilities and Behavioral Problems

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.

Practitioner's manual for standard stepping stones triple P

Facilitator’s manual for Group Stepping Stones Triple P: For families with a child who has a disability (2nd ed.)

Practitioner's Manual for Standard Stepping Stones Triple P: For Families with a Child who has a Disability