Fifteen-year follow-up study suggests Group Triple P led to long-term improvements in children’s literacy, numeracy and school attendance

shutterstock_373108393A 15-year follow-up of a Group Triple trial in Perth, Western Australia, suggests Triple P contributed to long-term improvements in literacy and numeracy for primary school children and better attendance for high-schoolers.

The Western Australian report, A 15 Year Follow-Up of the WA Triple P Trial, was prepared by Grant Smith at the Collaboration for Applied Research and Evaluation at the Telethon Kids Institute in Perth for the Western Australian Department of Health.

The study looked at 15 years of Western Australian administrative data to determine whether Triple P was associated with long-term benefits.

Performance on the Western Australian Literacy and Numeracy Assessment (WALNA) in Years 3, 5 and 7, as well as the rate of school absence in Year 11 from Department of Education databases, were linked to data from the original Western Australian evaluation of Group Triple P in 1996.

“Whilst the noted effects of the intervention on reading and numeracy achievement were small (between 2.0% and 5.5%), it is remarkable (though not unexpected) to find lasting academic effect of an eight session parenting intervention carried out when the child was between three and five years of age,’’ the report states.

“Given the relatively low time-burden Triple P poses for parents (a total of 10-12 hours) and the time between intervention and testing, these effect sizes are not insubstantial.’’

The study points out that differences between the groups who did and did not receive Triple P created some limitations. For example, geographic differences between the two groups suggest differences in schooling may be partially responsible for the observed effects.

“However, the dose-response pattern provides strong evidence for the intervention being responsible for the observed differences in academic performance,’’ the authors state.

Dose response links Triple P to better academic performance

The report explains that the more sessions parents attended, the more likely it was that children would have higher WALNA numeracy and literacy scores in year 7.

Despite a wealth of short- to medium-term studies showing the value of Group Triple P, there are few long-term studies into the effects of the intervention, apart from a four-year investigation of the universal availability of Group Triple P in a selection of preschools in Germany. This study demonstrated improved parenting behaviour (less dysfunctional parenting practices) four years after the intervention.

The Western Australian report also suggests that preschool children whose parents participated in Group Triple P between 1996 and 1997 were less likely to be involved in hospital emergency department visits than children in the comparison group.

However, despite a clear relationship between the intervention and the rate of emergency department visits, it was not conclusive whether this was due to Triple P or unmeasured differences between the intervention and comparison groups.

Group Triple P

Group Triple P is one of the more intensive forms of the Triple P – Positive Parenting Program and is generally accessed by families who have a child with behavioural problems or parents wanting more intensive support to develop positive parenting skills. It involves a combination of face-to-face group sessions and one-to-one telephone support sessions over eight sessions.

In Western Australia at the time of the original evaluation, the program was delivered by community health nurses, social workers, health promotion officers and psychologists recruited from community and child health services within the relevant health region. Facilitators attended a three-day intensive training program and were required to co-facilitate at least three programs with an experienced facilitator.

All families in the intervention group lived in an area where there were high rates of child abuse notifications and high rates of families receiving Family Crisis Program benefits. Families in the comparison group lived in an area with higher-than-state-average child abuse notifications and Family Crisis Program benefits – although not quite as high as the intervention regions.

The follow-up study also suggests Triple P increased use of of community mental health services. This finding might be explained by the fact that the Triple P curriculum encourages appropriate parental engagement with child development services or that a number of the Triple P-trained facilitators were able to refer to mental health services where they had a concern about a child’s psychological well being.

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Triple P goes to the White House

Representatives from Triple P America, the organisation licensed to disseminate Triple P in the United States, will attend the event at the invitation of the White House Office of Social Innovation and My Brother’s Keeper (MBK).

UQ Vice-Chancellor and President Professor Peter Høj said Triple P’s invitation to the White House showed a welcome belief that the pursuit of quality research could help overcome persistent global problems, such as a lack of opportunity for young men and boys of colour.

“The continued development and evaluation of Triple P internationally is an outstanding example of how research conducted in direct response to social need can inform the development of programs designed to improve the lives of individuals and  families while also providing community-wide benefits,’’ Professor Høj said.

Triple P founder and UQ Parenting and Family Support Centre director Professor Matt Sanders said the invitation to present at the White House was a strong endorsement for the program.

“The My Brother’s Keeper What Works presentation at the White House aims to give communities and the philanthropic and corporate sectors guidance on the type of quality, evidence-based programs they can be considering as part of this wonderful initiative,’’ Professor Sanders said.

“Internationally, and particularly in the US, we have seen that Triple P used in partnership with other evidence-based programs means great things can happen to provide opportunities for children and youth.’’

My Brother’s Keeper was established two years ago by US President Barack Obama to ensure all young people in the US reached their full potential.

Nearly 250 communities spanning all 50 US states have accessed $1.6 billion in private sector and philanthropic grants and low-interest financing as part of the initiative.

Triple P America Chief Executive Officer Bradley Thomas said Triple P had been invited to participate because its programs had been identified as being able to support the first of six My Brother’s Keeper milestone areas which encourage positive outcomes across the lifespan.

This milestone was ‘Getting a healthy start and entering school ready to learn’.

“Triple P America’s invitation to the White House is an indication of the strong evidence base of the Triple P system, as well as the outstanding results being obtained by sites rolling out the program in the United States,’’ Mr Thomas said.

The event can be viewed at https://www.whitehouse.gov/live

Home-visiting program plus Triple P shows significant improvements for children’s early cognitive development

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One of the most extensively conducted randomised controlled trials of an early childhood intervention program in Europe has shown that a home visiting program combined with the Triple P – Positive Parenting Program improved children’s cognitive development.

Results of a University College Dublin evaluation of the Preparing for life program include a finding that children in the high treatment group whose families participated in the full intervention had a 10-point IQ gap over children in the low treatment group.

Previous evidence of positive impacts of home visiting programs on children’s cognitive development before starting school has been limited.

As the study’s evaluation report states:

Only a small number of studies have found favourable intervention effects during the early years . .  However, the results are mixed and there is much variation in the effect sizes found by different programmes (Filene et al., 2013).

Preparing for Life (PFL) is a community-led initiative operated by the Northside Partnership in North Dublin and was evaluated over a seven-year period by the UCD Geary Institute under the direction of Dr Orla Doyle, an economist who has been awarded the Barrington Medal for her work in the economic and social sciences.

More than 200 families in designated disadvantaged areas of Dublin were involved in the trial, with the program aiming to help parents develop skills to help their children in five domains of school readiness:

  • cognitive development
  • physical health and motor skills
  • social, emotional & behavioural development
  • approaches to learning
  • language development and literacy

Parenting and Family Support Centre director and Professor of Clinical Psychology, Professor Matt Sanders, said PFL home-visiting mentors were trained to offer parents information about parenting and child development over a period of five years. They were also trained to deliver Triple P.

“Consequently, the principles and techniques of Triple P influenced the way in which mentors encouraged parents to interact with their children,” Professor Sanders said.

Access to a baby massage program was also available as well as access to additional Triple P programmes, such as Group Triple P.

The home visits started with mothers during pregnancy at 21 weeks and continued until the child started school at age four or five.

As part of the trial, a high treatment group received the full intervention, compared to a low-treatment group which did not receive the mentoring program, additional Triple P access or the baby massage program.

According to the final evaluation report, by school entry, the PFL program had a significant and large impact on children’s cognitive development. Children who received the high treatment supports had better general cognitive functioning, spatial abilities, non-verbal reasoning skills, and basic numeracy skills. This means that they were better at understanding information, seeing patterns, solving problems, and working with numbers.

 

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Major impacts when the children were at school entry age included:

  • children in the high treatment group had a 10 point IQ gap over children in the low treatment group
  • 25 per cent of high treatment children had above-average verbal ability, compared to eight  per cent of low treatment children
  • High treatment children were better able to control their attention
  • 25 per cent of high treatment children were not on track in their social competence compared to 43 per cent of low treatment children
  • High treatment children had better gross and fine motor skills

More specifically, the program was shown to have a significant and large impact on:

  • Children’s overall verbal ability
  • Expressive and receptive language skills
  • Communication and emerging literacy skills

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PFL had some impact on how children approached learning. Children who received the high treatment supports were better able to manage their attention.

PFL had a significant impact on:

  • Reducing children’s hyperactivity
  • Reducing inattentive behaviours
  • Improving social competencies and autonomy

 

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The program had a significant impact on reducing the amount of hospital services the children used and improved how families used these services. And children in the high treatment group were less likely to:

  • Visit the hospital for urgent reasons
  • Experience fractures
  • Visit the orthopaedics, physiotherapy, paediatrics, ocular and plastic surgery outpatient departments

 

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PFL also had a significant impact on

  • Children’s gross motor skills
  • Children’s fine motor skills
  • Physical independence

(Graphics used in this blog post have been sourced with permission from the final evaluation of Preparing for life by University of College Dublin’s Geary Institute.)

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How babies and a narrative of recovery might help mothers who experience postpartum psychosis

The role of the baby as both the cause and agent of recovery for women suffering from postpartum psychosis is part of the clinical and research work of Triple P Research Network member Dr Anja Wittkowski.

Two qualitative studies at the centre of this work were presented at the World Congress of Behavioural and Cognitive Therapies in Melbourne last month.

Dr Wittkowski’s research focuses on a time when most women anticipating the arrival of their baby are hoping to feel wonderful. But some may find themselves frightened, confused and, more than likely, sectioned under their country’s relevant Mental Health Act.

Dr Anja Wittkowski

Dr Anja Wittkowski

Rare but rapid onset

“Postpartum psychosis is quite rare, with around one in 1000 mothers giving birth experiencing it,’’ Dr Wittkowski said during a recent visit to UQ’s Parenting and Family Support Centre, following the World Congress. “It usually comes on very quickly within a few days of giving birth and it almost always requires an inpatient admission.

“It is an incredibly significant life event which can make the women who experience it question their very identity. But my impression is that many of these women go on to live normal, fulfilling lives as both women and mothers.’’

Dr Wittkowski said any pregnant woman could be at risk of developing the condition but an underlying bipolar disorder, or a previous postpartum psychosis, appears to increase the risk of experiencing it.

Dr Wittkowski is a senior lecturer in clinical psychology at The University of Manchester, the current Research Director for the Clinical Psychology Doctorate program at The University of Manchester as well as a clinical psychologist at the 10-bed Mother and Baby Unit (MBU) on Andersen Ward at Wythenshawe Hospital operated by the Manchester Mental Health and Social Care Trust.

Mothers who are admitted to Andersen Ward may be experiencing problems such as postnatal depression, postpartum psychosis or an exacerbation of an existing mental health problem, such as psychosis or bipolar affective disorder.

Dr Wittkowski’s first study involved conducting qualitative interviews with 12 women and was aimed at developing a theoretical understanding of recovery from psychosis following childbirth. This study was published in the journal BMC Psychiatry.

“We know from our first study that the first step in recovering from a postpartum psychosis is gaining an initial understanding of what you have experienced,’’ Dr Wittkowski said. “We know someone has a sense of realisation when they ask their friends or family, ‘what did I say, what did I do’, and can’t believe they did what their friends and family are telling them they did.

“Once they realise that they had very unusual (often psychotic) experiences, these women experience a great sense of loss. They had been anticipating that after giving birth they were going to experience the best feeling in the world but the next minute they are frightened and confused.

Losing a piece of themselves

“This period of experiencing acute psychotic symptoms is not viewed by these women as representative of what they are normally like. As part of recovery, they have told us that they had to accept that they have lost a little bit of themselves, such as their sense of security, their knowledge of being a stable persoverticle babyn or just time. But the women we interviewed told us that they used those experiences positively.

“In my clinical experience I can begin to see women recover when they start to develop a narrative about their experiences, partly as a way of explaining to others what happened to them – and why they had to b
e admitted to a psychiatric unit – but mostly so they have a way of explaining those very unusual experiences to themselves.’’

One of the women I worked with expressed this process of acceptance really nicely. She told me that she really liked musical animation. She explained that during her acute illness phase she was found hiding away in her room but singing these songs. She later said to me that singing these songs ‘helped me through the darkest moments in my life’.”

Because of the importance of psychosocial factors in the role of recovery, Dr Wittkowski said the research team asked the women in their first study about the things that had helped their recovery and the women identified that their relationships with family members and mental health staff had been very helpful.

“When these women talked about their relationships with others, one very strong theme emerged: none of these women mentioned their baby,’’ Dr Wittkowski said. “We were thinking about how odd that was and that informed the design of the second study. As the baby is a reason why women become extremely unwell in the first place, we wanted to know about the role of the baby in their recovery from postpartum psychosis.

Mothers who took part in the second qualitative study told us that the baby is central to their recovery and the baby was perceived a facilitator but the baby was also a barrier to recovery. These findings reflected what we had seen in clinical practice on the unit.

“The mothers also told us they felt they had to sacrifice their own wellbeing for the sake of the baby.’’

The second as yet unpublished study underlined the value of the work of the Mother and Baby Unit which centres around mothers’ wellbeing but also encouraging mothers to look after their babies and bond with them.

“We know that by looking after the baby, these women achieve a greater sense of self-confidence which helps their recovery,’’ she said.

Baby Triple P

Dr Wittkowski and fellow researchers are about to embark on a new study in which the Baby Triple P program will be offered at the Mother and Baby Units in Birmingham and Manchester. Funded by a National Institute of Health Research for Patient Benefit grant in the UK, they will be working with women who have been admitted for a range of mental health difficulties, including psychosis, postnatal depression, having thoughts of harming their child, stress, bonding problems, or existing problems, such as OCD, anxiety and/or depression.

“Baby Triple P just fits in so well with what we are doing,’’ Dr Wittkowski said. “When I first came across Baby Triple P I liked the fact that it had two sessions on dealing with the relationship between mother (or parent) and baby, two sessions for coping and building social support and four sessions for skill implementation via phone support.

“It’s really nice that there are four weeks of phone support so we get to see how the women manage the transition from having been on the unit to being back at home.”

“When we ran our mini-pilot, one of the women told me she really liked the idea of knowing that she could ring me after having been discharged from the Mother and Baby Unit.

“The study is a feasibility study looking at the possibility of recruiting women in this setting, whether they would be ok with being randomly allocated to treatment as usual plus the intervention or treatment as usual only and whether we can retain them throughout the study.’’

 

 

 

 

 

 

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.’’

 

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.

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.