matt at launch

Translating research into practice. Five-year evaluation of Triple P in California shows why helping parents can improve the health and wellbeing of the community

Part of my role as founder of the Triple P – Positive Parenting Program involves delivering masterclasses to practitioners who have been trained to deliver the program.

For the past five years, I have been travelling to California. Last Friday, I was back in California again. Only this time, I was there to support the launch of First 5 Santa Cruz County’s five-year evaluation report into the impacts Triple P has made in the community.

Santa Cruz was one of the first counties in California to implement Triple P following publication of our population trial which demonstrated that the Triple P system could help stem rising rates of child maltreatment.

In collaboration with partner organisations, First 5 decided to invest in Triple P to help local children reach their full potential after child abuse rates rose in the county in the years leading up to 2008.

The aim of First 5 is to ensure that family-friendly services and education are available so that each child reaches their fifth year of life healthy, ready and able to learn, and emotionally well developed.

Supported in training and implementation by our commercial partner, Triple P America, First 5 Santa Cruz County decided to provide the full Triple P system of programs at low- or no-cost, in English and Spanish, to local families with children aged up to 16.

The program is delivered by a number of local organisations and individuals through a partnership between First 5 Santa Cruz County, the Santa Cruz County Health Services Agency (via the Mental Health Services Act) and the Santa Cruz County Human Services Department.

Each year, Santa Cruz have conducted an evaluation of their work to see what level of impact Triple P is having. The launch I attended on Friday was the culmination of five years of those evaluations. And the report produced is an outstanding illustration of how Triple P can work with other policies and programs to make an impact on population-level indicators of child maltreatment.

The Santa Cruz model shows how effective a population-health approach to the provision of parenting support can be and is a superb example of how to translate research into everyday practice.

Their service-based evaluation found that:

  • Triple P is an effective and universal public health parenting intervention, reaching a broad population of parents
  • Triple P’s simple, practical parenting strategies are changing families’ lives for the better
  • Triple P is responsive to the needs of diverse families
  • Brief, “light touch” Triple P services are effective
  • Triple P has staying power, long after services have ended

It was enormously gratifying to hear county officials describe Triple P and its effects.

“Triple P is an invaluable partner for the Human Services Department,” Cecilia Espinola, Director of the Santa Cruz County Human Services Department and a Commissioner for First 5 Santa Cruz County, said.  “We share a common goal to strengthen families and improve outcomes for children.”

David Brody, Executive Director of First 5 Santa Cruz County, said:

“We have no doubt that the widespread, local availability of Triple P has been a vital contributor in the effort to help more children grow up in safe, stable, and nurturing families. Five-year data shows that Triple P has helped turn the curve on children’s health and well-being at a population level.’’

Dr Salem Magarian, Pediatric Director for Santa Cruz Community Health Centers and a Commissioner for First 5 Santa Cruz County, described Triple P as an outstanding model for helping parents:

“It’s an evidence-based program that’s been around for many years. It’s not just an industry standard, it’s a life standard to provide this kind of support, and it’s for all families.”

Cultural responsiveness and a common language

The five-year report suggests that both English and Spanish-speaking families, as well as both men and women, found the Triple P strategies relevant and helpful, indicating the cultural responsiveness of the Triple P model and the common language of positive parenting.

Evaluation data also showed that Triple P’s parenting strategies became tools that gained traction and usefulness with parents as they continued to learn, practice and self-evaluate their progress.

On average:

  • The majority of parents who completed in-depth Triple P services reported improvements in their children’s behaviors (80%), overall parenting style (77%), and level of stress (63%)
  • 95% of survey respondents reported they continue to use the Triple P strategies they learned, long after services have ended
  • 98% of Triple P participants surveyed reported they would recommend Triple P to their family and friends

The report, Strengthening Families in Santa Cruz County, 5-Year Report 2010-2015, is available here.

Turkish researchers show Group Triple P can treat anxiety in children

Turkish researchers have become the first to show that The University of Queensland’s Triple P – Positive Parenting Program can successfully target and treat clinical levels of anxiety in children.

Triple P is one of the world’s most extensively researched parenting interventions and is estimated to have reached millions of families.

However, much of the previous research of the past three decades has focused on prevention and treatment of early onset mental health problems in children such as disruptive behaviour problems.

“Traditionally treatments for anxiety and depressive disorders have focused on the individual child and it’s only been in recent years that research has focused on what role parents can have,’’ program founder and director of UQ’s Parenting and Family Support Centre, Professor Matt Sanders, said.

Anxiety is one of the most common mental health problems in adulthood and the second most common mental health disorder experienced by children and adolescents in Australia after ADHD. An estimated 6.9 per cent children and adolescents are estimated to be affected, latest government surveys suggest.

In their paper published in the Journal of Child and Family Studies, the Turkish authors point out that studies of humans as well as primates have shown that anxious children – or offspring – are particularly sensitive to the impacts of parenting, citing a study by Suomi (1997).

Parents who use harsh punishment, shouting and anger were likely to produce fear reactions in children, the authors, led by Gonca Özyurt, of the Child and Adolescent Psychiatry Clinic, in Nevsehir State Hospital, write.

Other parental factors such as anxious modelling, an over-controlling parenting style, ineffective disciplinary methods and child vulnerability factors such as their temperament, the way they think, and their age can also contribute to the likelihood of a child developing anxiety problems.

The children who participated in the Turkish study were on a waiting list at the Child and Adolescent Department outpatient unit at the School of Medicine in Dokuz Eylul University and were evaluated to have an anxiety disorder by a child psychiatrist.

“We aimed to evaluate the effectiveness of Triple P on childhood anxiety disorders and to assess its effects on behavioural and emotional problems, general anxiety level, severity of the disorder and general psychosocial functioning,’’ the authors write.

They also looked at the effects of the program on anxiety and psychological well-being of the parents.

This was a randomised controlled trial with parents of the Triple P group participating in Group Triple P for eight weeks, with the two groups compared just before and four months after the intervention.

Turkish-speaking practitioners were trained in the delivery of the program by UQ Associate Professor Alan Ralph and the program was delivered with Turkish-translated resources.

The authors conclude that “children’s anxiety level and severity of the disorder significantly decreased and the child’s functionality significantly improved with applying Triple P to children’s parents’’.

Although limited because of the size of the study (50 parents), they concluded that Triple P may be an effective and useful method of treatment for children and adolescents who have anxiety symptoms or anxiety disorders.

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Sometimes a light touch is all it takes: Triple P Seminars show benefits for Indonesian parents and their children

A randomised controlled trial involving Indonesian parents has shown a low-intensity parenting program can significantly improve children’s behavioural problems and parents’ confidence while reducing dysfunctional parenting practices and parents’ stress.

The delivery of the Triple P seminar series to 143 parents in Surabaya, Indonesia, is the first study to show that an evidence-based parenting program can be both effective and culturally acceptable for Indonesian parents.

It is also the first to show that a light-touch intervention can be effective in a developing country and one of only a few studies worldwide to have done so, regardless of the level of the intervention.

The Triple P – Positive Parenting Program takes a population health approach to parenting support with a multi-level system of programs available, from light-touch programs to more intensive, treatment-based approaches.

Professor Matt Sanders, director of the Parenting and Family Support Centre, said the finding was further support for a central tenet of this population approach, the principle of minimal sufficiency.

“We now have a significant body of work that shows that families, whether they are in Indonesia, China, Japan, or Australia, can derive real benefit from having parenting support that is adjusted and delivered in a dose that is appropriate to their needs,’’ Professor Sanders said.

“These were families with moderate problems yet the program still showed effects. It shows that reaching large numbers of parents with a low-intensity program that is both cost-effective and time-efficient is a practical as well as a particularly effective preventative health approach to take in low-resource settings.’’

A graduate of The University of Queensland’s Parenting and Family Support Centre, Dr Agnes Sumargi, currently a lecturer with Widya Mandala Catholic University in Surabaya, conducted significant research work in the lead up to publication of this study in the journal, Child Psychiatry and Human Development.

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Dr Agnes Sumargi.

An initial survey of 273 Indonesian parents living in Indonesia and Australia conducted in 2013 indicated that Indonesian parents often struggle with ineffective parenting practices such as making children apologise for misbehaviour, lecturing or shouting. And a large majority (78 per cent) said if help was available they would attend a parenting program.

In 2014, Dr Sumargi trialled the 90-minute Triple P seminar, The Power of Positive Parenting, with 30 Indonesian parents living in Australia. She delivered the seminar in Indonesian and results of the pilot showed the program was both culturally acceptable and likely to lead to less emotional and behavioural problems in children and less permissive parenting styles.

Then, in the randomised controlled trial published last year, Dr Sumargi invited Surabayan parents of a typically developing child between the ages of 2-12 years to attend the three 90-minute Triple P seminars: The Power of Positive Parenting, Raising Confident, Competent Children, and Raising Resilient Children, once a week. The seminars were delivered in Indonesian and most parents (88 per cent) attended all three seminars.

Dr Sumargi, and co-authors A/Prof Kate Sofronoff and A/Prof Alina Morawska, of the Parenting and Family Support Centre, point out this trial shows that a brief parenting program should now be tested with a wider audience in a community setting.

“Holding the seminar series in community sites, such as child care centres, schools, health care centres and religious sites may be especially beneficial as it can increase parents’ accessibility to and participation in the program.’’

They also suggest that not all parents require an intensive level of intervention, and this research demonstrates that providing a brief parenting program is effective for parents from diverse cultures.