Delivering a population rollout of the Triple P – Positive Parenting Program takes planning and commitment. But help is available. And the rewards are strong outcomes and sustained delivery

The team behind the successful rollout of the Triple P – Positive Parenting Program in the Irish Midlands has put its experiences into an implementation guide for other organisations wanting to improve the quality of life for children and parents at a population level.

The guide, Getting Started – Getting Better, sets out to help agencies considering implementing Triple P’s population health approach.

The Triple P multi-level system of parenting programs was delivered community-wide in the Irish Midlands by the Midlands Area Parenting Partnership (MAPP), which included representatives from the Irish Health Services Executive as well as community organisations. You can read about the evaluation of the project, funded by Atlantic Philanthropies, here.

That 2014 evaluation determined that a number of health outcomes for children and parents changed at the population level, including a 37.5 per cent drop in the numbers of children experiencing clinically elevated levels of social, emotional and behavioural problems.

When organisations such as MAPP and others around the world get it right, everyone wants to know the secret. With that in mind, the team behind MAPP have collected their experiences into a guide suitable for organisations with similar levels of capacity. It sets out to help organisations navigate what can often be the tricky process of embedding a system of evidence-based programs into a sustained delivery model that is implemented with fidelity.

Triple P founder and director of the Parenting and Family Support Centre at The University of Queensland, Professor Matt Sanders, described MAPP as a group which had valued the Triple P population approach from the start. MAPP had developed their own organisational structures to ensure the Triple P system was implemented with fidelity and quality assurance mechanisms were built in.

“MAPP understood from the outset the importance of building in local evaluations of evidence-based programs to ensure quality delivery. They learnt how to adapt to change and continue working on the sustained delivery of the program,’’ Professor Sanders said.

Best-practice example of organisational self-regulation

Professor Sanders described MAPP’s delivery of the Triple P system as a best-practice example of organisational self-regulation at work, to the extent that MAPP had designed their own system of implementation and evaluation to ensure the outcomes they were seeking for children and families were achieved.

“The principal of self-regulation and minimal sufficiency lies at the heart of the behaviour change model inherent in the Triple P – Positive Parenting Program and it’s always great to see this tenet at work with parents and children and practitioners. This is a great example of self-regulation and minimal sufficiency at work at an organisational level,’’ Professor Sanders said.

Around the same time as the MAPP rollout, The University of Queensland’s commercial partner in the worldwide delivery of Triple P, Triple P International (TPI), began to develop an Implementation Framework to create a way for TPI to support organisations in the delivery of Triple P, depending on the needs of the delivery organisation.

The story of how the TPI Implementation Framework was developed, the research and program delivery experience it was built on, and how it works to support organisations delivering Triple P has just been published in high-impact journal Prevention Science.

The Triple P Implementation Framework: The Role of Purveyors in the Implementation and Sustainability of Evidence-based Programs explains that while organisations are encouraged and supported to become independent problem solvers to overcome implementation obstacles (self-regulation), they are also supported from the outset by TPI Implementation Consultants. These consultants provide a level of support adjustable to the often differing levels of need of delivery organisations (minimal sufficiency).

Author of the Prevention Science article, Jenna McWilliam, described MAPP as a best-practice example of an organisation which had required a relatively minimal level of implementation support from TPI.

“The development of the Implementation Framework was prompted by feedback from organisations faced with challenges implementing Triple P, such as understanding the particular needs of implementing Triple P in the adoption phase and how to effectively sustain implementation,’’ Ms McWilliam said.

“It’s always extremely encouraging to see organisations understanding the model behind Triple P and applying it in various ways around the world,’’ Professor Sanders said. “They are taking the evidence and making it their own. We can only encourage and applaud such organisations while endeavouring to do everything we can to support others to implement the Triple P system.’’

 

Calls for evidence-based parenting programs to be made available to all as part of medical services in US

pediatric settingsAccess to parenting programs in primary care settings should be removed from an “at-risk’’ funding framework in the United States and be made universally available in pediatric settings, an article in the American Medical Association journal, JAMA Pediatrics, recommends.

The article, Parenting as Primary Prevention, is the latest in a string of recommendations calling for evidence-based parenting interventions to be integrated into services provided by US medical services.

Last month The University of Queensland-developed Triple P – Positive Parenting Program was included in an American Academy of Pediatrics policy recommendation to reduce the toxic effects of poverty on children’s health.

In the JAMA Pediatrics article, authors Dr Ellen Perrin, Dr Laurel Leslie, and Dr Thomas Boat argue that programs such as Triple P – , Family Check-Up, Incredible Years and Parent-Child Interaction Therapy have traditionally been located in the US under a mental health funding framework but this needed to change.

Locating funding for parenting interventions under a mental health framework meant that a child’s behaviour needed to be identified as “pathological’’ or the parents’ parenting style or other family characteristics have to be identified as “at risk’’ before families can access services, they argue.

“Parents report hesitation in accepting such referrals because of the stigma attached to their children’s behaviour and their own effectiveness,’’ the authors write.

Founder of Triple P and director of The University of Queensland’s Parenting and Family Support Centre Professor Matt Sanders said the development of the Triple P system of programs, designed to support large numbers of families across the population with varying degrees of needs, had gone a long way to destigmatise the notion of parenting support.

However, in Australia funding for parenting programs in primary care settings require parents access a mental health care plan before they qualify for support.

Professor Sanders said because a wealth of evidence showed that all parents can benefit from evidence-based parenting support, that support should be available to all in the same way as early child health care is available to every child.

 

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Why work might actually be good for you and your chronically ill child, and why you might want to cut yourself some slack

Parents juggling the guilt and pressure of work and family life might be pleased to know research shows keeping down a job is actually good for children.

Income from work can create better outcomes and well-being for children while other research suggests working parents are modelling a positive work ethic for their kids.

Unfortunately, such facts don’t appear to be helping the stress levels of most Australian parents.

In a recent Australian survey, nearly half (47%) of employed men with children under 15 said they felt as if they were always or often rushed or pressed for time. Unsurprisingly, more women (62%) felt the same way.

Despite the advantages that working parents provide for their children, balancing work, family and life in general clearly comes at a cost for parents.

Most of us know we should try to limit the overflow of home life into the workplace and vice-versa. But that’s a lot easier said than done.

Most of the time, parents are often just questioning themselves about whether they are doing the right thing at any given moment, such as missing a child’s doctor’s appointment, or answering that late-night work email.

We all try to make sacrifices and accommodations to keep both worlds afloat. Yet at some point, something on either side has to give, a spill-over called work-family conflict. And this conflict can do harm.

Undoing the gains

When we don’t manage work-family conflict, we risk undoing the gains we might have made by working in the first place by contributing to poorer health and wellbeing for ourselves and our children.

While most parents experience some level of work and family conflict, there are some families who experience much higher levels. Individuals who work longer hours and those who are carers often fall in this category.  What we don’t know is how do these experiences play out in parents who have even more demands and burdens placed upon them because their child is suffering from one or more of Australia’s common chronic illnesses.

The reality is that most chronic conditions require ongoing medical care and management.

And with extra expenses and costs, these parents – more than most – need to work to ensure the best possible outcomes for their children while juggling the needs of being a fulltime carer.

Research shows that chronically ill children whose parents work have statistically better outcomes because their parents can afford to get them to hospital for treatment, for example.

But what kinds of pressures does the work-family dynamic place on these families and do these additional pressures pose a health risk for these parents and their children?

Given the consequences family stress and conflict might be having on chronically ill children, along with the fact that childhood diagnoses of asthma, diabetes and eczema are on the rise, the need to understand parents’ experiences has become ever more pressing.

In order to understand the impact that work-family conflict might be having on families of chronically ill children, we are asking all parents of children aged between 5-12 years to complete a short questionnaire, regardless of whether they are caring for a chronically ill child or not.

We hope to determine whether parents of chronically ill children have higher levels of work and family conflict than parents of healthy children and to examine the impact of work and family conflict on the quality of life of both parents and children.  If you would like to contribute to this important research click here.