There is a solid evidence base to support the efficacy of therapist-led, group-based parent training interventions such as Incredible Years and Triple P. However, these types of programs can be costly to deliver, relying on many hours of trained therapists’ time. Moreover, parents hampered by problems with transport, childcare, and work commitments often find it difficult to attend groups.

By contrast, self-help interventions can be accessed easily at home by large numbers of people - a particularly attractive prospect given the rising rates of behavior problems among children in the UK - at significantly less cost to providers. Self-help interventions are clearly easy to deliver and inexpensive. But the real question is: do self-help interventions work?

They do, a new review of existing research suggests. For some families, a self-help approach can be as effective over the long term as a more traditional therapist-led intervention.

UK researchers Michelle O’Brien and David Daley report these findings in a forthcoming edition of Child: Care, Health and Development. The review examined evidence from 13 studies published in English language peer-reviewed journals. Many others did not meet the quality criteria applied in the selection process, which included baseline data measurement, at least one follow-up point, reliable primary outcome measures and a research design that involved a control group.

O’Brien and Daley defined self-help as “any therapeutic intervention that was presented either in written format (bibliotherapy) or multimedia format (DVD, CD-ROM, internet or TV), and designed to be implemented by the parent(s)”. They report that that this relatively low-cost, low-intensity approach to parent training can improve children’s behavior and is more beneficial than no treatment at all.

Although therapist-led programs generally have larger benefits than self-help over the immediate short term, follow-up studies reveal that the advantage diminishes over the longer term, at which point self-help approaches achieve similar levels of improvement in children’s behavior.

Adding only very minimal input from a therapist (less than 30 minutes a week) to monitor parents’ progress and troubleshoot problems also enhanced the impact of self-help parent training on both child and parental outcomes.

O’Brien and Daley argue that these findings provide evidence that self-help parent training could be a useful tool for practitioners. Self-help could be a resource for community nurses and health visitors dealing with children who have early-onset conduct problems or low-level behavior problems, for example.

They also propose that “self-help could form part of a stepped-care approach to treatment, where it may be used as the most basic and least intrusive level of intervention for families on waiting lists within specialist clinical services. Under these circumstances, self-help may prevent deterioration in child behaviour as the evidence supports the use of self-help compared with no treatment at all.”

The message is positive and the practical implications are clear. However, as the authors highlight, there are some caveats about the reliability and generalizability of the conclusions drawn from the 13 studies included in their review.

Whilst the majority of the studies have robust research designs that include randomly assigned control groups, a number of them have relatively small sample sizes and only a handful included independent observations of child behavior in addition to parent reports.

It is also not clear what the benefits of this less intensive approach are for families experiencing multiple stresses and risk factors such as low income, parental depression and single parenthood. The studies, for the most part, involved married Caucasian parents. More research is also needed to determine whether parent self-help has benefits for adolescents and more generally for children with conduct problems that meet clinical thresholds.

Despite these drawbacks and the need for further research, the main conclusions of the article do echo those made in a recent Cochrane review reporting that media-based self-help parent training has a moderate impact on child behavior problems. Many studies have shown that there are large volumes of unmet emotional and behavioral need among children and adolescents. The self-help method holds much promise for increasing access to interventions for those who need them the most.

References:
O’Brien, M., & Daley, D. (forthcoming). Self-help parenting interventions for childhood behavior disorders: a review of the evidence. Child: Care, Health and Development. doi:10.1111/j.1365-2214.2011.01231.x

Montgomery, P., Bjornstad, G. J., & Dennis, J. A. (2006). Media-based behavioural treatments for behavioural problems in children. The Cochrane Database of Systematic Reviews.