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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.

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.

Taking care of vulnerable children starts with empathy

When it comes to the difficult topic of child maltreatment, it’s easy to condemn. What might not be so easy to understand for parents who sacrifice the second car for the school fees or drive hundreds of kilometres each weekend taking kids to social and sporting events, is that even parents found guilty of neglecting their children want better lives for their kids.

I’ve often seen this in clinical practice. It’s not that struggling parents lack the will to provide a safe and loving environment for their children. What they are lacking are the skills, knowledge and confidence to create the kind of environment where children feel safe, loved and secure, where kids can grow up to become capable people ready to deal with the world and its challenges.

The lives of parents struggling to look after children can be full of turmoil and riven by poverty, a situation reinforced by social structures where a lack of opportunity is transmitted from one generation to the next.

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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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