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.

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Queensland Government rollout of Triple P launched with free parenting seminars

A large media contingent was present for the official launch of the Queensland Government and Triple P International’s Queensland-wide roll-out of the Triple P – Positive Parenting Program at Broncos Leagues Club last Wednesday.

Triple P founder and director of the University of Queensland’s Parenting and Family Support Centre, Professor Matt Sanders, pictured above with Queensland Government Communities Minister, Shannon Fentiman, officially launched the rollout with a seminar on the Power of Positive Parenting at Broncos Leagues Club for more than 100 parents and carers.

Later that night, it was standing room only for around 150 carers at the same venue. These seminars were followed by three more in the Logan district.

“We know parenting is hard work, and we are committed to making sure all Queensland mums, dads, grandparents and caregivers know they are not alone in raising the next generation of Queenslanders,” Ms Fentiman said.

Ms Fentiman said the Government was not in the business of telling Queensland families what to do.

“It’s about letting them know that it’s okay to ask for help,” she said.

Professor Sanders praised the Government for intervening early to help Queensland families before major problems develop down the track.

“Lots of programs focus on the pointy end, the difficult families who have already experiended major, major problems,” Professor Sanders said at the launch. “This is about the prevention of those problems.”

Earlier, in an interview with ABC Radio 612 that morning, Professor Sanders explained how Level 2 Triple P Seminars give parents a taste of other, more intensive forms of help available, should they need it.

“Doing a seminar is a bit of a taster: you come in, you’re given a chance to really pause and reflect on the parenting issues you’re confronting, and how you’re dealing with them,Matt Ch 7” Professor Sanders said.

“You decide whether or not what you’re doing is working. If it’s working, keep doing what you’re doing. It’s not about preaching to people that they must do differently.”

Professor Sanders said it was rewarding to see the work of so many researchers and students from the PFSC acknowledged by the Queensland Government’s support of the two-year trial. It was also gratifying to see the Government get behind this Queensland success story and become the first government to offer the full suite of Triple P programs, including Triple P Online, to families of children up to the age of 16.

Channel Seven Brisbane News also featured Professor Sanders in the studio, pictured at right, in its coverage of the event. That coverage is available here.

Minister Fentiman’s press release announcing the launch is available here.

Parents can find out how to participate in a Triple P session here.

 

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Ireland and the population-level effect: How schools were the key to reaching those most in need

Brief interventions played a major role in the success of a population-level delivery of the Triple P system in the Irish Midlands, the director of the partnership involved in the rollout, Conor Owens, told this year’s Helping Families Change Conference (HFCC) in Amsterdam.

The Longford Westmeath Parenting Partnership made Triple P available free to all parents of children under the age of eight to reduce prevalence rates of clinically elevated social, emotional and behavioural problems in children, estimated to be one in five children in Ireland.

Their goal was also to help parents become more confident and feel more supported, as well as to reduce parents’ levels of anxiety and depression relating to their children’s behaviour.

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Triple P making headway in Japan

Prof Matt Sanders with Associate Professor Chiyomi Agami, from the Fukuoka Prefecture University. Dr Egami has been running Triple P Group and Stepping Stones Group Triple P courses as a practitioner in Japan.

Prof Matt Sanders with Associate Professor Chiyomi Egami, from the Fukuoka Prefecture University. Dr Egami has been running Triple P Group and Stepping Stones Group Triple P courses as a practitioner in Japan.

The use of the Triple – Positive Parenting Program to treat and prevent child maltreatment may be finding high-level support in Japan, an article in last week’s Yomiuri Shimbun suggests.

Triple P founder and director of the University of Queensland’s Parenting and Family Support Centre, Prof Matt Sanders, was in Japan last week to address the Japanese Society for the Prevention of Child Abuse and Neglect.

Prof Sanders met with the Governor of Wakayama Prefecture, Yoshinobu Nisaka, and raised the importance of governments taking a public health approach to treat and prevent problems of child maltreatment.

The meeting was covered by Yomiuri Shimbun, a newspaper regarded as having the largest readership in the world with a daily circulation of more than 13 million readers.

Governor Nisaka is quoted in Yomiuri Shimbun as saying that he would like to actively implement Triple P.

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Can a childcare centre help prevent child maltreatment? AIFS study underlines the importance of a population approach

Moving a percentage of the population away from behaviours that can have a long-lasting impact on society has long been a key driver behind the development of the multi-level Triple P system.

Now a report by the Australian Institute of Family Studies (AIFS) underlines the importance of a population approach to prevent child maltreatment and the role that family interventions can play.

The report refers to a Productivity Commission recommendation for the involvement of child care and early learning centres in risk assessment and early intervention to protect children. As well as providing a safe learning environment for children, early learning centres could also help improve life at home by offering skills development and information to parents.

The report, A safe and supportive family environment for children: Key components and links to child outcomes (2014, Mullan K and Higgins, D) analyses data from the AIFS longitudinal study, Growing Up in Australia, to identify the prevalence of different types of family environments and their links to children’s health and well-being.

The study looks at outcomes for children from different types of families and tracks what happens when those family environments change.

Among the findings:

  • Children from families displaying below-average levels of parental warmth and parent-child shared activities and above-average levels of hostile parenting – identified as disengaged families – had lower Year 5 NAPLAN reading and numeracy scores.
  • Children aged 2-3 from families displaying average levels of parental warmth but higher than average levels of parental conflict – identified as enmeshed families – were more likely to be underweight.
  • And children aged 2-3 from disengaged families were more likely to have one or more injuries per year.

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Evaluation of Triple P delivery in NSW shows what is needed to make ‘the transition from good science to better service’

It’s always extremely gratifying to see the work that we do translated into an inter-agency, government-backed effort that transforms the lives of families.

But the NSW Government is to be congratulated not just for the work they are doing in making Triple P available free for families of children aged 3 to 8.

Their continual evaluation of the implementation of Triple P in NSW is taking the program’s reach beyond the welfare sector and into the broader community where it will make the most impact.

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