Evaluating an Online Parenting Support System Disseminated by Pediatric Practices

Disruptive behavior problems are among the most prevalent mental health conditions for young
children, and they carry significant risks for later socioemotional, conduct, and academic
problems, such as substance abuse, delinquency, and school failure. How parents handle these
challenging behaviors strongly influences their children's long-term trajectory.
Evidence-based parenting programs have shown much value in reducing early-onset disruptive
behavior problems, thereby reducing risks for later substance abuse and other behavioral
health problems. The reach of parenting programs is limited, however, by significant
challenges in recruiting, engaging, and retaining parents, such that most parents who could
benefit from parenting assistance never receive it. A public health approach for improving
parenting practices that makes evidence-based parenting programs widely available and
accessible in a range of formats could reduce the prevalence of disruptive behavior problems,
and thus the population-level risk for substance abuse and other adverse outcomes.
Internet-based intervention offers significant potential as part of a population-wide
strategy for bringing evidence-based parenting practices to a broad range of parents
experiencing challenges in raising their children. Furthermore, pediatricians could be a
natural touchpoint for reaching families with evidence-based parenting supports. The field
knows little, however, about the potential of the internet to strengthen parenting practices,
or about how pediatric practitioners might be engaged in improving the reach of an online
parenting program. This study will experimentally evaluate an internet-based version of the
Triple P Positive Parenting Program, the Triple P Online System (TPOS), which presents the
Triple P content in an interactive, video-enriched, and personalized format with 3-levels of
flexible dosage, and will compare it against usual community services. Thirty pediatric
clinics involving 100 practitioners in 9 counties across western Washington will be recruited
and randomized to receive (a) access for their patients to the Triple P Online System and
training in how to effectively promote TPOS and advise parents on their children's behavior
problems or (b) Usual Care Community-Waitlist Control, in which parents will be assisted with
an appropriate referral for services in the community. Practitioners will recruit into their
respective conditions 400 families of 3-8 year-old children with elevated behavior problems.
Measures of parents' parenting practices, family functioning, children's disruptive behavior
problems, and practitioners' protocols for advising on behavior problems will be obtained at
baseline, post-intervention, and 1-year follow-up. The efficacy of the Triple P Online System
in improving these outcomes will be examined, as well as dosage-response relationships. This
study will further our understanding of the potential value of promoting internet-based
parenting programs through pediatric practitioners. Maximizing the reach of evidence-based
parenting programs has the potential to reduce the prevalence of children's behavior
problems, and thus reduce risks for later problems such as substance abuse.

Inclusion Criteria:

- Pediatric practitioners at participating clinics in western Washington.

- Families of children 3-8 years old referred by participating pediatric practitioners.
Eligible families will: (a) have a child 3-8 years old, (b) have at least half-time
custody of the child, (c) care for the child at least 16 waking hours per week, (d)
express concern to their practitioner about difficulties with the child's behavior,
(e) score .80 standard deviation or more above the normed mean on the Eyberg Child
Behavior Inventory, (f) speak English, and (g) have regular access to high-speed
internet.

Exclusion Criteria: