San Diego delivery of Triple P a powerful illustration of how a population approach can work

An evaluation of the delivery of the Jewish Family Service of San Diego’s Positive Parenting Program in a low-income, Spanish-speaking community is a powerful illustration of how a population approach can improve the lives of children and their families, Triple P founder, Professor Matt Sanders, says.

jfs logoThe Triple P – Positive Parenting Program was chosen by the County of San Diego to promote social and emotional wellness for children and families living in at-risk, low socio-economic communities with a high concentration of ethnic minorities.

The County provided Jewish Family Service with a Mental Health Services Act Prevention and Early Intervention Grant to provide Levels 2, 3 and 4 of Triple P through the delivery of Triple P Seminars, Individual (Primary Care Triple P) and Group Triple P.

JFS conducts regular evaluations of its implementation of Triple P. In 2013-14, its evaluation showed significant improvements for the majority of parents and children who participated in the program.

While change occurred across a range of child and parent outcomes, the largest improvements came following Group Triple P for children in the clinical range for conduct problems and social, emotional and behavioural concerns, and for parents’ whose self-reports placed them at clinical levels of depression. In both examples, most parents and children in the clinical range moved into the normal range.

Triple P founder, Professor of Clinical Psychology and Director of The University of Queensland’s Parenting and Family Support Centre, Matt Sanders, said the fact that JFS was able to reach such large numbers of families and record extremely high rates of program completion and satisfaction in a predominantly low-income, Spanish-speaking community was extremely rewarding to see.

“The JFS implementation model demonstrates just what can be achieved by following good practice in program delivery,’’ Professor Sanders said.

“It shows that quality parent education can benefit all cultures and economic environments. Parents have a universal need for support and this evaluation shows those needs can be met and that barriers to services can be addressed by dedication and creativity.’’

Mandate for early intervention and prevention support

Director of Positive Parenting for JFS in San Diego, Lea Bush, said the Triple P mix of light-touch seminars combined with more intensive programs for families with greater levels of need provided an ideal way for JFS to fulfill its mandate to provide early intervention and prevention support services for families across the targeted population.

The JFS evaluation, conducted by consultant Susan Hedges, shows uniformly large effect sizes for children in the clinical range of social, emotional and behavioural problems with the majority of these children moving into the normal range after their parents participated in Group Triple P.

From this group of families, of the 86 children assessed to be in the abnormal range for conduct problems, 74 per cent (or 64 children) improved following Group Triple P, with 63 per cent (54 children) moving into the normal range. Similar levels of improvement were recorded for children with abnormal levels of emotional problems (76 and 60 per cent), hyperactivity (88 and 81 per cent), peer relationship problems (72 and 51 per cent) and total difficulties (88 and 70 per cent).

Replicating clinical trial results, JFS parents’ depressive symptoms improved following Group Triple P across a range of functioning from mild to severe. Eighty-two per cent of parents with mild to moderate levels of depression moved to the normal range, while 67 per cent of parents with severe to extremely severe depression moved to the normal range.

High retention rates of parents

The evaluation also shows high retention rates of parents across the range of Triple P programs delivered with very high levels of parent satisfaction.

Ms Bush said the delivery of Triple P Seminars in elementary and pre-schools across San Diego provided an ideal initial access point into the community.

“Parents really enjoy the low-barrier, easy engagement model of Triple P Seminars because there are not too many expectations placed on them to participate or interact,’’ Ms Bush said. “We provide seminars directly at preschool and elementary school sites and ask that parents attend all three sessions of the seminar series to receive a ‘completion certificate’.

“As needed or desired by parents, we then enrol families from Level 2 into Level 4 Group or Level 3 Individual programs. It works very well because parents learn in the seminars that this is a safe place to learn about ways to improve their children’s behavior and they develop trust and rapport with other members of the preschool or community. They then become more willing to engage in higher levels of service when necessary.’’

Over the 12-month period, JFS Parent Educators delivered to 2831 parents or other individuals such as school or child care staff who attended at least one session of Triple P. At least 3500 children were estimated as benefitting.

Since 2009, Triple P has reached an estimated 10,262 adults in San Diego, benefitting an around 19,972 children in the County.

A vast number of sites are served by the JFS program annually, with more than 100 sites reached each year for the past two years, including Head Start centers.

Ms Bush said the organisation went to great lengths to remove any potential barriers to parents attending programs, providing incentives ranging from free babysitting, snacks, laundry soap, transportation and children’s books.

“Our parent education staff are really empowered to make relationships directly with the sites they serve, so they get to know the staff, the parents, the teachers and use those relationships to compel attendance by as many parents as possible,’’ Ms Bush said.

“All our staff are what we call “para-professional” or “peer-based” staff who were hired for their ability to connect with the community. This is another hallmark of how we are able to develop rapport.’’

Copies of the report are available upon request from Ms Bush, Director of Positive Parenting at Jewish Family Service of San Diego, leab@jfssd.org

‘Now, when there is a problem, I just breathe and I deal with the problem with no anger. This is good. For me, I think the program has changed my life.’

 

Evidence of cultural acceptability in research trials is one thing.

But a video produced by a local authority in the United Kingdom which is delivering Triple P Seminars, Triple P Discussion Groups and Group Triple to parents is a convincing argument for the way the program can help parents across all sections of the community.

Depicting a group of women participating in an Arabic-speaking Group Triple P session in Brighton and Hove, the video is also a great illustration of the cultural acceptability of the program.

Arabic-speaking and Triple P International-trained and accredited Triple P practitioner Kafa Atar, who leads the group in Brighton and Hove through her work with the local authority’s Ethnic Minority Achievement Service, has lived in five Middle Eastern countries, including Iraq for the most part, but also in Syria for two years.

She is passionate about helping families settle in the United Kingdom from these countries and says that timing is everything when it comes to offering parenting support, following a thorough assessment of needs and readiness.

Kafa says Triple P can help parents negotiate the sometimes tricky transition to school. But it also can help families negotiate their new life.

“For me, it’s for two purposes,” Kafa says in the video. “It’s to bridge the gap between two cultures. Our parenting style is very different . . . We are scared of English culture.”

In the video Kafa says that addressing bad behaviour is all about establishing routines. Establishing good routines can have an effect on a child’s learning as well as having an impact on their lives at school.

Kafa says the use of praise is not common in Middle Eastern parenting culture but through the group sessions, parents learn that it can be a powerful tool.

Parents participating in the video also provide a great illustration of how they are now dealing with life now.

“Now, when there is a problem, I just breathe and I deal with the problem with no anger,” says mother Areej Al-Jwait, from Iraq. “Now they (the children) become more honest and they come to me and they tell me the problem without any fear. And I will be quiet and I breathe and I deal with the problem. This is good. For me . . . I think the program has changed my life.”

EMAS team leader Sarah Berliner said EMAS also delivers Triple P programs in Polish, Chinese, Pashto and have just trained staff for Bengali and Oromiffa-speaking families.

“It is really powerful and meaningful work and makes such a difference to the outcomes for the pupils and their families,” Ms Berliner said.

The video was produced by independent UK producer Cathy Maxwell, who volunteered her services for EMAS.

 

matt masterclass brighton

Uplifting, gratifying and professionally rewarding: Triple P Masterclasses in the UK, Ireland and Germany show that the program is in good hands

For someone who grew up in a boys school famous for turning out All Blacks, last weekend’s Rugby World Cup final was a personal highlight of my recent trip to the United Kingdom.

But the professional highlight would have to be the Masterclasses I felt privileged to deliver to Triple P practitioners around the UK, Ireland and in Berlin over the past few weeks.

The energy in the rooms for individual Masterclasses might not have matched Twickenham Stadium with 80,000 fans for the final, but for me collectively they came close.

If participating in Masterclasses is like taking the pulse of Triple P implementation in the community, then the program is in great hands.

There were strong numbers at the masterclasses, such as in Brighton, pictured above. Of course, this is personally satisfying but strong attendance also signals that good local implementation of Triple P is in place, that practitioners value the program and obviously see a great fit for the families they’re seeking to help.

Many of the practitioners who came to the Masterclasses are achieving outstanding outcomes with some very complex families.

We had some excellent question and answer sessions where practitioners had the opportunity to ask me the most difficult clinical questions they could think of.

Working with complex families

These questions certainly kept me on my toes and highlighted once again the extremely diverse ways that organisations and practitioners are using Triple P to help a great range of families, such as parents in prison, families with complex mental health problems and those with learning disabilities.

In Germany, there was intense interest for the German version of Triple P Online.

During meetings I tried to convey the immense value to communities in having a well-trained and supported workforce to deliver evidence-based practices such as Triple P.

It was also great to see the team from Falkirk, pictured below, with their award for Triple P delivery and use of the Peer Assisted Supervision and Support (PASS) implementation model.

PASS draws on Triple P’s self-regulatory model and draws support from the use of peers rather than expert mentoring. The idea is to empower practitioners and increase sustainability of program delivery within organisations.

Triple P and the Psychology of Parenting Project in Scotland

Falkirk was one of the pilot sites for the Psychology of Parenting Project, which has embedded the delivery of Triple P and The Incredible Years programs within a suite of complementary training activities and organisational supports throughout Scotland.

Thanks to everyone involved for making my Masterclass series such an enjoyable and professional rewarding experience.

Hopefully more local authorities will see the true value of adopting the full multilevel system of Triple P within a public health framework.

falkirk pic