Turkish researchers show Group Triple P can treat anxiety in children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Dr Agnes Sumargi.

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

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

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

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

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

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

 

 

 

 

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.

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.

 

 

 

 

 

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

‘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.