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Impact of Pathways Triple P on Pediatric Health-Related Quality of Life in Maltreated Children

Lanier, Paul, PhD*; Dunnigan, Allison, MSW; Kohl, Patricia L., PhD

Journal of Developmental & Behavioral Pediatrics: December 2018 - Volume 39 - Issue 9 - p 701–708
doi: 10.1097/DBP.0000000000000608
Original Article
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Objective: Child maltreatment is an adverse childhood experience associated with reductions in child well-being. This study examines whether an evidence-based parenting intervention delivered to families served by the child welfare system (CWS) affects pediatric health-related quality of life (HRQoL).

Method: This study is a randomized controlled trial of Pathways Triple P (PTP) delivered to families with open child welfare cases for child physical abuse or neglect (N = 119). Children were 5 to 11 years old and remained in the home after the investigation. The primary outcome measure for this study was the Pediatric Quality of Life Inventory (PedsQL) 4.0, which measures HRQoL across 4 subdomains: physical functioning, emotional functioning, social functioning, and school functioning. Child- and parent-reported PedsQL 4.0 was assessed at baseline and post-test after the 14-week intervention.

Results: Controlling for other factors, children in families randomly assigned to the PTP condition had a significant improvement in overall HRQoL after the intervention compared with families receiving usual services (βchild-report = 6.08, SE = 2.77, p = 0.03; βparent-report = 3.83, SE = 1.88, p = 0.04). Subdomain effect sizes differed when considering children's self-report or parents' proxy report. Children's self-report yielded the largest improvement in emotional functioning, whereas social functioning had the largest gain based on parents' proxy report.

Conclusion: The PTP parenting intervention was associated with higher pediatric HRQoL as reported by both the child and parent. This intervention holds promise to improve child well-being when implemented in the CWS.

*University of North Carolina at Chapel Hill, Chapel Hill, NC; and

Washington University in St. Louis, St. Louis, MO.

Address for reprints: Paul Lanier, PhD, School of Social Work, UNC-Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC 27599-3550; e-mail:

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (1R01HD061454-04A1).

Disclosure: The authors declare no conflict of interest.

Trial Registration: 5R01HD061454.

See the Video Abstract at

Received March 02, 2018

Accepted June 18, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.