To adapt or not to adapt: Paper finds Group Triple P has ‘social validity’ with African American fathers

shutterstock_219865159Practitioners should not hesitate to use Triple P with African American fathers, a paper co-authored by US researcher Patricia Kohl, of the George Warren Brown School of Social Work at Washington University in St Louis, concludes.

The study, published in Best Practice Mental Health, looks at the engagement of African American fathers in Group Triple P by comparing a group which was shown limited Triple P materials, including video resources, with a group who received the full intervention.

Conducted with the use of focus groups and interviews, the study found that providing fathers with only a small amount of information from program resources could actually be a barrier to potential participation – or at least perceptions of the value of the program.

Many of the fathers involved in the study spoke about initial concerns that program materials did not provide examples using African American fathers or urban settings similar to their own. However, fathers who participated in Group Triple P had a much more detailed perspective and could identify with many of the scenarios of daily life presented.

“For fathers who were exposed to the complete intervention, it appears to be a socially valid intervention,’’ Dr Kohl and co-author Kristen Seay, of the College of Social Work of the University of South Carolina, write. “However, when Triple P is used with this population, it is important to tailor examples to the circumstances of culturally diverse groups and to use language with which urban African American fathers relate.’’

The paper points out that since the early 1990s, the diversity of mothers involved in Triple P research has increased but this has not been the case for African American fathers who, until this study, remained almost completely absent from the Triple P evidence base.

The authors also describe how the highly segregated, disadvantaged urban communities in which African American fathers often must parent their children present very difficult circumstances such as high crime rates, drugs, gang violence, and few resources. But assumptions should not be made about a program’s social validity without actually asking the fathers, and those who work to support them, what they think.

“It is essential that practitioners or researchers considering the adaptation of an ESI (evidence supported intervention) to a new culturally diverse population do not make assumptions about how the target population views the intervention or about the fit between the population and the ESI,’’ the authors argue. “The voices of the target population, as well as those of other key stakeholders such as those providing services to the population, must be heard in this process (McKleroy et al, 2006).’’

Interviews with fathers from the two groups are highly contrasted in the paper. After watching a snippet of the Triple P DVD, several fathers across all five focus groups who did not participate in Triple P felt that they could not identify with several aspects of the intervention. One father said:

“When an urban neighborhood has a big crime rate, your kids don’t come home like that. Your mom ain’t cooking at home like that… . If you look at this program, you’d be like it’s not like that in this environment… . It’s a different environment.”

In contrast, fathers who received the complete intervention were far more positive. A number of examples were supplied in interviews of how they recognised themselves in the material and how they applied that information to their lives and saw a difference. One father said:

“I used to be more aggressive with them but now I am just calming down.”

After recognising his role in his child’s behavior for the first time, another said:

“After that session last week, I just went home and I just thought about everything that was going on, and I came to the conclusion that it wasn’t really so much as my kids that were giving me the problem—it was really myself that was causing all the problems.’’

The authors write: “That is a very powerful statement given that the parent is the change agent in BPT interventions. It is through changing the parent’s behavior that children’s behavior improves.’’

They conclude that more efforts are needed to understand the transportability of Triple P to African American fathers and to further explore the acceptability of Triple P by non-traditional service settings, such as father support agencies.

 

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Coming full circle: Triple P as a catalyst to reconnect young Indigenous parents and children with their cultural heritage

Picture a crammed circle of chairs in a conference room, with 50 dedicated family support workers and researchers from around the world discussing how we can enhance services in Indigenous communities. What an amazing opportunity to share experiences and insights, and to engage more of the professional community in this much-needed work. The recent Helping Families Change Conference in Banff in Canada provided just that.

We don’t get the chance to do this often enough. We had the rare privilege of hearing, first hand, about the journeys of Canadian, New Zealand and Australian First Nations peoples. It was a precious hour and a half that many participants said was a healing process in itself.

We are at a point in time when reconciliation and closing the gap in health, educational and social inequality are national priorities for governments around the world.

In a recent speech to Parliament to table the 2016 Closing the Gap statement, the Prime Minister of Australia, Malcolm Turnbull, called on the words of Chris Sarra, the chairman of the Stronger Smarter Institute, to explore what would truly make a difference to Australian Indigenous lives. Quoting Chris, the Prime Minister set out the following three priorities:

“Firstly, acknowledge, embrace and celebrate the humanity of Indigenous Australians. Secondly, bring us policy approaches that nurture hope and optimism rather than entrench despair. And lastly, do things with us, not to us. Do things with us, not to us.”

These were the exact sentiments expressed by participants in our discussion group, representing diverse First Nations peoples.

There are so many parallels in the experiences of Indigenous communities that have a history of colonisation. These experiences have included, but are not limited to, displacement from country, from family, from language, from ritual, from sacred laws, from spiritual connection, from cultural identity and pride.

As researchers and practitioners working with Indigenous or First Nations families, this gathering reminded us that we need to start at the beginning of each family’s story. This means learning about and acknowledging what generations before have experienced. What traumas did they suffer? What parenting strengths and wisdom have been passed down?

Then, if we are to truly engage with families, we need to make our services appealing and accessible. Trust is the crucial thing.

Each practitioner has their own standing and relationships in community, and can develop those relationships by deepening their understanding and respect for local culture. They can engage with and learn from Elders, partner with Aboriginal organisations, and work with local champions who see the value of bringing evidence-based programs out of universities and into reality in community to give every child the best possible chance in life.

Our own research has shown that a parenting group can be a first, safe step in accessing a service agency, and can lead to parents developing the confidence and trust to access other health, mental health and community services.

Truly humbling

We’ve come a long way. I was first approached in 1996, when Triple P was brand new and dissemination was a fledging process, to look at somehow making Triple P more attractive, relevant and accessible for young Indigenous families in Brisbane.

These young parents were in trouble – with day-to-day problems coping with the law, with cultural identity, with racism, and with the struggle of living in two societies.

We consulted with community representatives locally, then state-wide, and then nationally and made steps towards making Triple P culturally sensitive and engaging.

It is truly humbling to see so many wonderful practitioners around the world take those small steps that we made in a little office in Brisbane 20 years ago and make them flourish.

It also heartens me to think that some of those first ‘Triple P babes’ have now grown up and are doing great work in their communities. A whole new generation of positive, motivated Indigenous parents.

Over the years, we have learned that success comes when communities choose when they are ready for change, and when researchers, developers and communities work together to decide how they want to incorporate existing programs to meet the community’s needs. As Chris Sarra said, doing it together.

It’s not so much that programs need to change, it’s that the way they are delivered that needs to have relevance and context.

Draw on traditions to connect with each family’s origins

Our discussion group impressed that, in the end, it is not up to program developers to somehow create myriad localised variations to incorporate every culture into their programs. It’s up to practitioners to incorporate programs into their own ways of being and understanding. The aim is to implement evidence-based programs flexibly, without losing the key ingredients. Practitioners should embrace local culture and draw on each tribe’s own traditions to connect to each family’s origins, and help them find their own cultural knowledge, aspirations and practices.

As one Indigenous practitioner said at HFCC in Banff:

“It’s about bringing Triple P to our culture, not the other way around.”

To be truly pan-Indigenous, a program needs to provide a structure to connect effective parenting principles and strategies to each family’s lived experience of family. Flexible tailoring is not only permitted, it is required … for each family, community and era.

The principles and practices of positive parenting are not new. As one of the group participants shared with us:

“Our great grandmothers were patient and firm. Triple P is helping our families come back to our cultural traditions. It’s bringing us full circle.”

Pride and gratitude

These words make me so proud of what we are achieving collectively. There are so many people to thank for sharing their knowledge, learnings and successes with Triple P over the years, and most recently at the HFCC. Such enthusiasm and openness feed our passion for making programs such as Triple P accessible to every family.

Imagine if more Indigenous communities around the world could help reconnect young parents with their cultural heritage using evidence-based programs such as Triple P as a catalyst. Building strength on strength.

As a program developer and researcher who has spent the last 20 years exploring the fit of Triple P in Indigenous communities, this feedback has been overwhelming. I really do believe we are coming full circle.