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Stepping Stones Triple P: the importance of putting the findings into context.

Tellegen CL, Sofronoff K - BMC Med (2015)

Bottom Line: The Stepping Stones Triple P (SSTP) parenting program is an evidence-based program for parents of children with a disability.The results are inconsistent with previous evidence for SSTP, yet the authors provide scant interpretation for this inconsistency.Similarly, the unusually high dropout rate of 49% was not adequately explained.

View Article: PubMed Central - PubMed

Affiliation: School of Psychology, The University of Queensland, St Lucia QLD 4072, Australia. k.sofronoff@psy.uq.edu.au.

ABSTRACT
The Stepping Stones Triple P (SSTP) parenting program is an evidence-based program for parents of children with a disability. A trial of SSTP was recently published in BMC Medicine, which reported results of a randomized controlled trial comparing SSTP to care-as-usual. Although the paper described what should be an important replication trial of SSTP, there are significant shortcomings to the scientific approach of the reporting that need to be addressed. The paper initially cites only a few published SSTP studies and describes evidence for the efficacy of the program as "very scarce". A meta-analysis of studies evaluating SSTP published prior to submission of this paper was not cited. The results are inconsistent with previous evidence for SSTP, yet the authors provide scant interpretation for this inconsistency. Similarly, the unusually high dropout rate of 49% was not adequately explained. The claims that previous research has only been conducted by the developers, has not included children with intellectual disability, and has not used care-as-usual comparison groups, are inaccurate. This commentary explores these issues further in order to place the findings from the recent trial into context.

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Related in: MedlinePlus

Effect sizes for different levels of SSTP interventions based on data from the SSTP meta-analysis[2].d, standardized difference effect size; n, number of trials; SSTP, Stepping Stones Triple P-Positive Parenting Program.
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Fig1: Effect sizes for different levels of SSTP interventions based on data from the SSTP meta-analysis[2].d, standardized difference effect size; n, number of trials; SSTP, Stepping Stones Triple P-Positive Parenting Program.

Mentions: The authors describe the previous research on SSTP as being ‘weak’ or ‘very scarce’, stating: “Although SSTP seems promising, evidence of its effectiveness is very scarce” [1]. While the authors use the term ‘effectiveness’ in this sentence, they seem to be referring instead to efficacy research and therefore this comment will be interpreted accordingly. The authors reference only four RCTs evaluating the efficacy of SSTP programs and one uncontrolled study. At the time of submission, there were numerous other published and unpublished trials. A more accurate representation of the current evidence base would have cited the SSTP meta-analysis published in 2013, which included 12 studies combining data from 659 families [2]. Figure 1 displays a summary of the effect sizes from the SSTP meta-analysis [2] on child problem data for the different levels of SSTP interventions. In total, there have been nine published RCTs evaluating SSTP, and only four of these were selected for citation. According to standard guidelines, two rigorous RCTs with significant short- and long-term effects are needed for an intervention to be considered efficacious [3]. It is clear that SSTP meets the criteria for an efficacious intervention, and to describe the evidence as ‘very scarce’ is a significant misrepresentation.Figure 1


Stepping Stones Triple P: the importance of putting the findings into context.

Tellegen CL, Sofronoff K - BMC Med (2015)

Effect sizes for different levels of SSTP interventions based on data from the SSTP meta-analysis[2].d, standardized difference effect size; n, number of trials; SSTP, Stepping Stones Triple P-Positive Parenting Program.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4316393&req=5

Fig1: Effect sizes for different levels of SSTP interventions based on data from the SSTP meta-analysis[2].d, standardized difference effect size; n, number of trials; SSTP, Stepping Stones Triple P-Positive Parenting Program.
Mentions: The authors describe the previous research on SSTP as being ‘weak’ or ‘very scarce’, stating: “Although SSTP seems promising, evidence of its effectiveness is very scarce” [1]. While the authors use the term ‘effectiveness’ in this sentence, they seem to be referring instead to efficacy research and therefore this comment will be interpreted accordingly. The authors reference only four RCTs evaluating the efficacy of SSTP programs and one uncontrolled study. At the time of submission, there were numerous other published and unpublished trials. A more accurate representation of the current evidence base would have cited the SSTP meta-analysis published in 2013, which included 12 studies combining data from 659 families [2]. Figure 1 displays a summary of the effect sizes from the SSTP meta-analysis [2] on child problem data for the different levels of SSTP interventions. In total, there have been nine published RCTs evaluating SSTP, and only four of these were selected for citation. According to standard guidelines, two rigorous RCTs with significant short- and long-term effects are needed for an intervention to be considered efficacious [3]. It is clear that SSTP meets the criteria for an efficacious intervention, and to describe the evidence as ‘very scarce’ is a significant misrepresentation.Figure 1

Bottom Line: The Stepping Stones Triple P (SSTP) parenting program is an evidence-based program for parents of children with a disability.The results are inconsistent with previous evidence for SSTP, yet the authors provide scant interpretation for this inconsistency.Similarly, the unusually high dropout rate of 49% was not adequately explained.

View Article: PubMed Central - PubMed

Affiliation: School of Psychology, The University of Queensland, St Lucia QLD 4072, Australia. k.sofronoff@psy.uq.edu.au.

ABSTRACT
The Stepping Stones Triple P (SSTP) parenting program is an evidence-based program for parents of children with a disability. A trial of SSTP was recently published in BMC Medicine, which reported results of a randomized controlled trial comparing SSTP to care-as-usual. Although the paper described what should be an important replication trial of SSTP, there are significant shortcomings to the scientific approach of the reporting that need to be addressed. The paper initially cites only a few published SSTP studies and describes evidence for the efficacy of the program as "very scarce". A meta-analysis of studies evaluating SSTP published prior to submission of this paper was not cited. The results are inconsistent with previous evidence for SSTP, yet the authors provide scant interpretation for this inconsistency. Similarly, the unusually high dropout rate of 49% was not adequately explained. The claims that previous research has only been conducted by the developers, has not included children with intellectual disability, and has not used care-as-usual comparison groups, are inaccurate. This commentary explores these issues further in order to place the findings from the recent trial into context.

Show MeSH
Related in: MedlinePlus