A web-based randomised controlled trial exploring the impact of telephone-based practitioner support in an online parenting program.

Triple P is a multilevel system of behavioural family interventions that aims to prevent and treat child social, emotional and behavioural problems by enhancing parenting confidence, knowledge and skills. Triple P Online is an 8-module web-based program that fits within level 4 of the Triple P system. Modules take approximately 30-60 minutes, with each module needing to be completed (or 'unlocked') in sequence. The program covers the key concepts of positive parenting including strategies for managing misbehaviour, teaching children new skills, and encouraging desirable behaviour. Modules are labelled as follows: 1) What is positive parenting? 2) Teaching new skills 3) Managing misbehaviour 4) Dealing with disobedience 5) Preventing problems by planning ahead 6) Making shopping fun 7) Raising confident, capable kids 8) Encouraging behaviour you like. The program features video, interactive activities, downloadable resources, a dynamic workbook generated based on user activity, and technology-assisted reminders (e.g. SMS, email). Users are encouraged to set goals for change, and monitor and assess progress periodically throughout the program. Users are also encouraged to think about high-risk situations by combining strategies and principles learned throughout the program into a cohesive prevention plan, with the eventual aim of reducing reliance on the program so supports can be phased out. This is a three-arm trial, with two active intervention groups and a computer-use-as-usual control condition. The two active conditions compare practitioner-supported Triple P Online with self-directed Triple P Online. Arm 1 Participants randomised to the first arm of the trial are given access to Triple P Online as a standalone self-directed intervention. Program access expires four months from the date of first login. This arm includes minimal participant contact; specifically limited to technical support (e.g. a user has lost their password and is unable to login) or to notify of their upcoming program expiry date (one month prior to expiry and again one week prior). No clinical practitioner support is provided, and participants are able to proceed at their own pace through the program without external prompting regarding the rate or frequency of module completion. Arm 2 Participants in this group are given the same access to Triple P Online as those in Arm 1, expiring four months from the date of first login. In addition, each parent is allocated to a practitioner trained in Level 4 Triple P, who provides up to eight telephone consultations. Consultations usually last around 15 minutes, with a maximum of 30 minutes per call. The primary purpose of the clinical consultations is to encourage and support parental self-regulatory skills, offer psychoeducation, help tailor the program to the specific family environment, encourage and assist with goal setting, provide constructive feedback, and troubleshoot any practical or motivational barriers the parent might be experiencing. Technical support is typically referred back to the principal investigator. Practitioners aim to schedule consultations weekly, beginning with the first session scheduled for a week after an introductory phone call from the practitioner. Parents are encouraged to complete Module 1 of the online program prior to the first telephone session, and then one module each week between phone sessions thereafter. However practitioners are able to negotiate sessions as necessary to fit around the practitioner/parent schedule, which may result in more than one week between some sessions. If a parent keeps their phone appointment but has not progressed any further through the online program, the call will continue as best as possible maintaining the core aims of clinical support, albeit limited to a discussion of content from prior modules. The parent would then be encouraged to continue through the next online module for the following week. Regarding missed sessions, for example the parent does not answer at the arranged time, some rescheduling is allowed however parents may receive less than the full eight phone consultations if this occurs repeatedly. Actual number of completed telephone sessions (for Arm 2) and online modules (for Arm 1 & 2) will be tracked throughout the trial for each parent. Arm 3 This is a computer-use-as-usual control group. Parents in the control group receive no treatment during the trial, however after completion of follow-up data collection (nine months from pre-intervention assessment) parents are provided with access to Triple P Online as a self-directed program, expiring four months from date of first login. No clinical practitioner support is provided to parents in this arm.