***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Approximately 20 % of children experience internalizing or externalizing DSM-IV-TR disorders . This prevalence rate can not be reduced through treatment only . Effective preventive interventions are therefore urgently needed . The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems . Methods Based on their respective preschool , N = 280 families were r and omly assigned either to the parent training or to the control group . The efficacy was analyzed using multi- source assessment s , including question naires by mother and father , behavioral observation of mother-child interaction , and teacher evaluations . Results At the 2-year follow-up , both parents in the Triple P intervention reported significant reductions in dysfunctional parenting behavior , and mothers also an increase in positive parenting behavior . In addition , mothers reported significant reductions in internalizing and externalizing child behavior .  Single-parent mothers in the Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group . Neither mother-child interactions nor teacher ratings yielded significant results . Conclusions The results support the long-term efficacy of the Triple P - group program as a universal prevention intervention for changing parenting behavior in two-parent households , but not necessarily in single-parent mothers Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement BACKGROUND Despite a wealth of evidence showing that behavioural family intervention is an effective intervention for parents of children with behavioural and emotional problems , little attention has been given to the relationship between parents functioning at work and their capacity to manage parenting and other home responsibilities . This study evaluated the effects of a group version of the Triple-P Positive Parenting Program ( WPTP ) design ed specifically for delivery in the workplace . METHOD Participants were 42 general and academic staff from a major metropolitan university who were reporting difficulties managing home and work responsibilities and behavioural difficulties with their children . Participants were r and omly assigned to WPTP , or to a waitlist control ( WL ) condition . RESULTS Following intervention , parents in WPTP reported significantly lower levels of disruptive child behaviour , dysfunctional parenting practice s , and higher levels of parental self-efficacy in managing both home and work responsibilities , than parents in the WL condition . These short-term improvements were maintained at 4-months follow-up . There were also additional improvements in reported levels of work stress and parental distress at follow-up in the WPTP group compared to post-intervention . CONCLUSIONS Implication s for the development of ' family-friendly ' work environments and the prevention of child behaviour problems are discussed The outcomes of a r and omized clinical trial of a new behavioral family intervention , Stepping Stones Triple P , for preschoolers with developmental and behavior problems are presented . Forty-eight children with developmental disabilities participated , 27 r and omly allocated to an intervention group and 20 to a wait-list control group .  Parents completed measures of parenting style and stress  , and independent observers assessed parent-child interactions . The intervention was associated with fewer child behavior problems reported by mothers and independent observers , improved maternal and paternal parenting style , and decreased maternal stress . All effects were maintained at 6-month follow-up This paper examined the effects of a parenting intervention targeting working parents called Workplace Triple P. The intervention targeted both parenting and work factors , focusing on key transition times ( e.g. , from home to work ) and trained parents to more effectively manage these transitions . One-hundred- and -twenty-one working parents with children ranging in age from 1 - 16 years were r and omly assigned to either a Workplace Triple P condition ( WPTP ) or to a waitlist control condition ( WLC ) . Results showed that parents who had received the intervention reported significantly lower levels on measures of personal distress and dysfunctional parenting ; and higher levels of work commitment , work satisfaction , and self-efficacy . Implication s for the delivery of parenting interventions as employee assistance programs are discussed along with how such interventions can enhance work and family life A pilot trial provided some evidence that the Triple P Positive Parenting Program is effective with and acceptable to a Japanese population in Australia ( Matsumoto , Sofronoff , & S and ers , 2007 ) . This effectiveness study aim ed to address theoretical and practical concerns related to the parent training program in community setting s in Japan . The research used community re sources within an ecological framework . Fifty-four Japanese families living in a Tokyo metropolitan area were r and omly assigned to either a treatment or a wait-list control group .  Program effects and acceptability were examined and then compared with the outcomes from the trial with Japanese parents living in Australia . The results showed significant program effects and high levels of acceptability of the program and core parenting skills , which was consistent with the pilot trial . The findings provided support for the effectiveness and sociocultural validation of Triple P in Japanese society . Intervention effects and program acceptability as well as limitations and future research are discussed This study examined the efficacy of a brief 2-h discussion group for parents of preschool children that show disruptive behavior on shopping trips . Forty-six parents with children aged 2–6 years were r and omly assigned to either the intervention condition or a waitlist control group . Significant intervention effects were found for measures of problem child behavior , dysfunctional parenting styles and parents ’ confidence in the parenting role . No group differences were found for parental adjustment or conflict over parenting . Intervention gains were maintained at 6-month follow-up . Results are discussed within a primary care and public health framework The present study evaluated the effectiveness of the Positive Parenting Program ( Triple P ) with a sample of Chinese parents of children with early onset conduct-related problems in Hong Kong . The participants consisted of 91 parents whose children attended maternal and child health centers and child assessment centers for service , and were between three to seven years old . Participants were r and omly assigned to the intervention ( TP ) and a waitlist control group ( WL ) . There was no significant difference in pre-intervention measures between the two groups . However , at post intervention , participants in the TP group reported significantly lower levels of child behavior problems , lower dysfunctional parenting styles , and higher parent sense of competence , compared to the WL group . Implication s of these findings for the use of Triple P with families of Chinese descent are discussed This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P ( SSTP ) using 74 preschool-aged children with developmental disabilities . Families were r and omly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills ( SSTP-E ) , st and ard parent training intervention alone ( SSTP-S ) or waitlist control ( WL ) condition . At post-intervention , both programs were associated with lower levels of observed negative child behavior , reductions in the number of care-giving setting s where children displayed problem behavior , and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition . Gains attained at post-intervention were maintained at 1-year follow-up . Both interventions produced significant reductions in child problem behavior , with 67 % of children in the SSTP-E and 77 % of children in the SSTP-S showing clinical ly reliable change from pre-intervention to follow-up . Parents reported a high level of satisfaction with both interventions BACKGROUND To test effectiveness of a parenting intervention , delivered in a community-based voluntary-sector organisation , for reducing conduct problems in clinical ly-referred children . METHODS R and omised controlled trial , follow-up at 6 , 18 months , assessors blind to treatment status . Participants --76 children referred for conduct problems , aged 2 - 9 , primarily low-income families , r and omised to treatment vs. 6-month wait-list group .  Retention was 93 % at 6 months , 90 % at 18 months . Interventions --Webster-Stratton Incredible Years video-based 14-week group programme , teaches cognitive-behavioural principles for managing behaviour , using a collaborative , practical , problem-solving approach . Primary outcomes --child problem behaviour by parent-report ( Eyberg ) and home-based direct observation ; secondary outcomes --observed positive and negative parenting ; parent-reported parenting skill , confidence and depression . RESULTS Post-treatment improvements were found in child problem behaviour , by parent-report ( effect size ( ES ) .48 , p = .05 ) and direct observation ( ES .78 , p = .02 ) ; child independent play ( ES .77 , p = .003 ) ; observed negative ( ES .74 , p = .003 ) and positive ( ES .38 , p = .04 ) parenting ; parent-reported confidence ( ES .40 , p = .03 ) and skill ( ES .65 , p = .01 ) , using ANCOVA to control for baseline scores . Maternal depression did not change . Consumer satisfaction was high . At 18-month follow-up , although no r and omised comparison was possible , changes appeared to maintain , with no significant change toward baseline level on any measure . Change in observed positive parenting appeared to mediate change in child problem behaviour ( p < .025 ) . CONCLUSIONS Findings suggest that a group-based cognitive-behavioural parenting programme , delivered by well-trained and supervised staff , can be effective in a community voluntary-sector setting , for reducing conduct problems and enhancing parenting skills . Change in parenting skill appears to be a key mechanism for change in child behaviour . Findings have implication s for feasibility of translating evidence -based programmes , even for clinical ly-referred conduct problems , into less specialised community setting s , likely to have lower costs and be more accessible for families Objective To evaluate the effectiveness of a parenting programme as a preventive intervention with parents of preschool children considered to be at risk of developing conduct disorder . Design Pragmatic r and omised controlled trial using a block design with allocation by area . Setting Eleven Sure Start areas in north and mid-Wales . Participants 153 parents from socially disadvantaged areas , with children aged 36 - 59 months at risk of conduct disorder defined by scoring over the clinical cut off on the Eyberg child behaviour inventory . Participants were r and omised on a 2:1 basis , 104 to intervention and 49 to remaining on the  wait  listing ( control ) . Twenty ( 13 % ) were lost to follow-up six months later , 18 from the intervention group . Intervention The Webster-Stratton Incredible Years basic parenting programme , a 12 week group based intervention . Main outcome measures Problem behaviour in children and parenting skills assessed by self reports from parents and by direct observation in the home . Parents ' self reported parenting competence , stress , and depression . St and ardised and well vali date d instruments were used throughout . Results At follow-up , most of the measures of parenting and problem behaviour in children showed significant improvement in the intervention group . The intention to treat analysis for the primary outcome measure , the Eyberg child behaviour inventory , showed a mean difference between groups of 4.4 points ( 95 % confidence interval 2.0 to 6.9 , P<0.001 ) on the problem scale with an effect size of 0.63 , and a mean difference of 25.1 ( 14.9 to 35.2 , P<0.001 ) on the intensity scale with an effect size of 0.89 . Conclusion This community based study showed the effectiveness of an evidence based parenting intervention delivered with fidelity by regular Sure Start staff . It has influenced policy within Wales and provides lessons for Engl and where , to date , Sure Start programmes have not been effective . Trial registration IS RCT This article reports the effectiveness of two universal prevention programs in reducing externalizing behavior in elementary school children . A sample of 1,675 first grade rs in 56 Swiss elementary schools was r and omly assigned to a school-based social competence intervention , a parental training intervention , both , or control . Externalizing psychopathology and social competence ratings were provided by the children , primary caregivers , and teachers at the beginning and end of the 2-year program , with a follow-up 2 years later . Intention-to-treat analyses revealed that long-term effects on teacher- and parent-rated externalizing behavior were greater for the social competence intervention than for the control . However , for most outcomes , no statistically significant positive effects were observed Objective To determine whether a parenting programme , offered universally in primary care , can prevent behavioural problems in children and improve parenting and maternal mental health . Design Cluster r and omised trial . Setting 40 primary care nursing centres ( clusters ) in Victoria , Australia . Participants 733 English speaking mothers of 8 month old children sequentially recruited from well child appointments ; 656 retained at 24 months . Intervention Structured three session programme at age 8 - 15 months , 
    Output:
    
We found no convincing evidence that Triple P interventions work across the whole population or that any benefits are long-term .