Golden hour in Sonoma Valley wine country in autumn. Sun beams through low clouds over rows of grapevines at harvest time.

Helping Families Change Conference 2018 – Save the date!

We are pleased to announce that the 19th Helping Families Change Conference will be held in Santa Rosa in Sonoma County, California, USA from 28th February to 2nd March 2018.

We look forward to seeing you in Sonoma Valley, traditional home of the Miwok, Pomo and Wintun peoples, and an area considered the birthplace of wine-making in California. A visit here offers the chance to experience the Pacific Coast, San Francisco Bay Area, giant redwoods, antiques and the beautiful Sonoma Valley Wine Country.

Stay tuned for more conference program details available soon at the HFCC website.

Reducing the risks for recently settled families

Parenting and Family Support Centre PhD student Kathryn Monty has been highlighted in a video produced by The University of Queensland for her work in creating change for migrant families in Queensland.

More information on Kathryn’s trial, which seeks to promote the wellbeing and adjustment of resettled families and help their integration and participation in community life, is available here.

 

Meta-analysis finds Triple P effective in preventing antisocial behaviour and delinquency

More evidence has come to hand that parenting programs are an effective evidence-based strategy to prevent antisocial behaviour and delinquency.

A meta-analysis update on the effects of early family/parent training programs on antisocial behaviour and delinquency (Piquero et al., 2016) is an excellent and timely study which shows the huge value that evidence-based parenting programs represent.

If you think about the costs of violent and anti-social behaviour to society, for very little outlay, parenting programs reward investors many times over.

The study, published in the Journal of Experimental Criminology, updates and replicates Alex Piquero’s previous work published in 2009 which found that early family/parent training “is an effective intervention for reducing behaviour problems among young children’’.

The authors conclude:

“In short, early family/parent training programs are an important evidence-based strategy that deserves continued application and expansion as part of a more general strategy for building a safer society.’’

In comparing different interventions, the review authors place Triple P’s effect size of 0.56 midway between Parenting-Child Interaction Therapy (0.98) and The Incredible Years (0.37).

This is an extremely encouraging finding given that PCIT adopts a treatment approach, focusing on more difficult cases with “more room to move’’.

PCIT and, to a lesser extent, The Incredible Years are targeted, treatment interventions for families with children with well-established conduct problems.

In contrast, the Triple P multilevel system of parenting support is based on a population-based public health model which seeks to shift prevalence rates across the community.

Triple P’s approach blends early intervention, light touch programs designed with prevention in mind with more enhanced, targeted treatment options.

The Triple P studies reviewed by Piquero et al. included a mix of different delivery modalities such as over-the-phone, self-directed, and television programs – representing a mixture of brief, low-intensity prevention interventions (Sanders, Montgomery & Brechman-Toussaint) – and more intensive enhanced interventions (Sanders, Markie-Dadds, Tully & Bor).

Prevention interventions usually have lower base rates of problems and therefore less room to “improve” whereas treatment interventions such as PCIT typically have higher base rates and much greater capacity to show change over time as well as larger effect sizes.

An intensive intervention with multiple sessions (12 or more) may produce larger effect sizes than briefer interventions (eight or less sessions) but a brief intervention may have greater impact because it’s less expensive to deliver with more families able to be seen with the same allocation of practitioner time.

Generally meta-analyses of parent training have not looked at these issues of cost and population reach that an intervention can achieve.

Both treatment and prevention approaches are important and both need to be incorporated in any effort to treat and prevent anti-social behaviour and delinquency.

However, issues such as practitioner availability and the amount of time that parents can dedicate to participation are important factors that agencies need to weigh up when considering how to implement a prevention health approach.

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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.

 

 

 

 

 

A public health approach to child maltreatment prevention is critical, argues University of South Carolina’s Professor Ron Prinz

In the emerging field of child maltreatment prevention, public health approaches to prevent child abuse are novel but necessary, the director of the University of South Carolina’s Parenting and Family Research Center, Professor Ron Prinz, writes in a recent edition of the journal, Child Abuse & Neglect.

Ron Prinz

Professor Ron Prinz

Professor Prinz argues that interventions focusing on improving parenting are a crucial ingredient to the prevention of child maltreatment. However, few parents will sign up for a program that explicitly sets out to reduce child abuse.

He suggests that researchers who have been trained in disciplines that focus heavily on strategies which help one family at a time, or in small groups, could benefit from lessons learnt from public health campaigns, such as anti-smoking and public safety campaigns.

“Several years ago, parking lot footage played repeatedly on CNN of an abusive parent caught in the act was both alarming and informative,’’ Professor Prinz writes.

“The parent first buckled the young child into a car seat located in the back seat and then proceeded to pummel her with fists. Somehow even an abusive parent had been affected by public health messaging to secure the child properly in the car seat.’’

Professor Prinz said that while it was still an open question whether public health strategies could make a dent in child-maltreatment related indicators at a population level, several years ago, his group conducted a controlled study to test the proposition using the Triple P—Positive Parenting Program system.

“Despite power constraints associated with having only 9 Triple P counties and 9 comparison counties, the study showed that large effects could be produced on child out-of-home placements, child hospital-treated maltreatment injuries, and CM substantiations,’’ Professor Prinz writes.

“This type of study sorely needs to be replicated, although getting communities, states, and funders to embrace a place randomization design is not easy.’’

He says that while broad parenting intervention is important, it must be joined with other critical facets of a public health approach, such as the need to address poverty factors and parental substance abuse.

Professor Prinz argues that the parenting-focused aspects of child maltreatment prevention can extend beyond the original goal, including the prevention of childhood social, emotional, and behavioural problems; the reduction of risk for adverse adolescent outcomes (such as substance use, delinquency and academic failure); and parental engagement for school readiness.

He also suggests that media can help normalise help-seeking behaviour among parents and provide positive models of how parents can encourage pro-social behaviour in their children while providing boundaries without resorting to coercive parenting practices.

A public health approach does not mean, Prof Prinz argues, that all parents receive equal access to the same “dose’’ of support.

“Universal access to parenting support is important, but this does not mean every parent in the population needs to participate in the same intensity, or even any, level of parenting support,’’ Professor Prinz writes.

“A blended approach to prevention makes the most sense, which means indicated, selective and universal preventive interventions are combined in an organized framework.’’

The article points out that some families also need support in relation to basic needs, such as food, housing and medical care, parental substance-use problems, mental health disorders, or other specific conditions.

Professor Prinz also suggests that public health approaches to child maltreatment prevention could benefit from linking parenting-focused interventions to broad community mobilisation strategies.

“Efforts like Strong Communities (developed by psychologist Gary Melton and colleagues), which seeks to change the culture within neighbourhoods to one of mutual engagement and assistance, are compatible with interventions that champion and promote pro-social parenting and positive contagion for the raising of healthy children,’’ he writes.

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

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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To reach parents in a culturally sensitive way we first need to listen to the local community

More than 90 per cent of the world’s children and families live in low- and middle-income countries.

So how do we reach them in a culturally sensitive way?

In our project in Panama, we tested the efficacy of Triple P Discussion Groups with 108 parents from six high-risk, low-resource neighborhoods.

Even though the intervention was delivered in its original form, “intuitive” cultural adaptations took place during delivery.

For example, we started sessions with an ice breaker activity, we worked with local facilitators and used local jargon when giving examples.

I come from a family of social workers in Panama and so my passion has always been to support families living in poverty.  But to help them in a respectful way, I firstly needed to understand what is it like to live and raise a child in a high-risk neighbourhood.

I also wanted others around the world to understand the experiences of families living in poverty.  I was pretty sure that images would speak louder than any words.

The idea then was to film a short documentary in collaboration with two mothers from San Joaquin.

San Joaquin is a high-risk community in Panama City recognized as the epicenter of violence and home to the deadliest gangs in the country.  This 10-minute documentary follows the life of Cecilia and Dora, two mothers who also took part in the Triple P intervention.  It’s interesting to see how both mothers show great resilience in their discourse even though they are facing daily adversity.

Filming this documentary made me understand the importance of using collaborative approaches to increase engagement of community members with new interventions.  This documentary allowed me to give voice to mothers who would otherwise not have any platform to speak up.  They felt as if they were active participants disseminating results from the project and became the main advocates for it.  Participatory research such as this increases ownership, sustainability and ensures interventions fit local needs and culture.

Using this work in Panama as a case example, and in collaboration with other researchers at the Parenting and Family Support Centre at the University of Queensland, I’m currently involved in developing and testing models to approach new communities in a collaborative, participatory way.

We feel it’s important that programs are sustainable once they have been introduced into a new community. In order to do this, we’re exploring models or ways to listen to the community and learn about its local history.

By doing this, we hope to understand how local people who want to bring about change in those communities would like to deliver the program, rather than imposing change from the top down.

We are developing guidelines to conduct cultural engagement in a systematic manner.  These guidelines will provide “conceptual lenses” to practitioners and researchers delivering and implementing Triple P in any context or culture worldwide, such as with families in low- and middle-income countries, refugee parents and Indigenous communities in Australia.

And in turn, we hope to give the voice of change back to the community.

Note: All participants provided written informed consent for the dissemination of this footage for academic purposes.

For more information on the RCT:  Mejia, A., Calam, R., & Sanders, M.R. (2015).  A pilot randomized controlled trial of a brief parenting intervention in low resource settings in Panama. Prevention Science. DOI: 10.1007/s11121-015-0551-1