COPE

An Ounce of Prevention: COPEing with Toddler Behaviour
Niccols, A
Canadian Journal of Psychiatry 2005, 50: 185-186

INTRODUCTION
Disruptive behaviour disorders are major mental health problems that are difficult to treat, and costly to society in terms of suffering, violence, and damaged property.  The most common reason for referral to children’s mental health services involves disruptive behaviours, which are quite stable from toddlerhood.  Intervention may be more effective with younger children, who tend to have less severe behaviour problems, however there are no evidence-based interventions specifically targeting toddlers.[1]

BACKGROUND

Group-based parent training can be effective, cost efficient, and accessible, so we developed “COPEing with Toddler Behaviour” to train groups of parents in effective parenting strategies for toddlers (12 to 36 months) using an active learning model (i.e., COPE “Community Parent Education” [2]) that has been used successfully with other age groups.  In the development phase of this community-based education group, we focused on enlisting and retaining parents of at-risk toddlers, completing evaluations, identifying any negative impact of the groups, and developing the content in response to feedback.

METHOD

We advertised and offered three 3-session versions of “COPEing with Toddler Behaviour” in high-risk neighbourhoods, as poverty (and associated factors such as poor housing and living in high-crime neighbourhoods) has been identified as a predictor of disruptive behaviour disorders.  To help enlist and sustain group involvement, we provided snacks, childcare, and help with transportation.  Each of the three weekly sessions was two hours in length, held at convenient locations, and led by experienced group facilitators.

The groups filled up quickly (i.e., we had a waiting list).  Over three offerings, 90 parents registered by telephone and 48 parents (53%) completed at least 2 of the 3 sessions.

RESULTS

All 48 parents completed a client satisfaction questionnaire and reported that they highly valued the course: 88-100% said they learned something new, plan to use what they learned, and found the course helpful.  One-third thought the course was too short. 

Of the 48 parents, 16 (62% of the 26 we were able to reach by telephone to elicit agreement) completed pre-test, post-test, and follow-up standardized parent-report measures.[3]  Results showed small to medium effect size decreases in difficult toddler behaviour, dysfunctional parent-child interaction, and parental distress, and a significant increase in knowledge of toddler parenting issues.  We found no negative effects.

Over the next several years, we gradually expanded the course from 3 sessions to 8 sessions in response to feedback and in an attempt to make it more effective.  There was no decrease in enlistment or client satisfaction.  Retention improved with the addition of incentives (meals and prizes; 65% completed at least 5 of 8 sessions).  We developed a manual for facilitators.

CONCLUSIONS

We successfully achieved our goals in developing the COPEing with Toddler Behaviour group (i.e., enlisting and retaining parents of at-risk toddlers, completing evaluations, identifying any negative impact, and further developing the content), however, the pilot study involved a short version of the course, a small sample, no control group, and parent-report measures only.  A randomized clinical trial represents the next step in this research.

References

1. Mrazek P, Brown H.  An Evidenced-based literature review on outcomes in psychosocial prevention and early intervention for families with young children.  Toronto (ON):  Invest in Kids; 2002.
2. Cunningham CE, Bremner R, Boyle M. Large group community-based parenting programs for families of preschoolers at risk for disruptive behavior disorders: utilization, cost effectiveness, and outcome. J Child Psychol and Psychiatry 1995; 35: 1141-59.
3. Abidin R. Parenting Stress Index (3rd Ed.) Professional manual. Odessa (FL): Psychological Assessment Resources; 1990.

Financial support for this study was received from the Canadian Psychiatric Research Foundation and the Ontario Mental Health Foundation, and by McMaster Children’s Hospital and McMaster University.  A portion of this paper was presented at the World Association for Infant Mental Health conference, Amsterdam, July 2002.

Alison Niccols is a member of the Offord Centre for Child Studies and an Assistant Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, Hamilton, Ontario, Canada.