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

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

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

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

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

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

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

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

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

Dose response links Triple P to better academic performance

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

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

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

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

Group Triple P

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

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

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

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

dads

When fathers are more actively involved in parenting, both parents are happier with their relationship: How parenting interventions improve couple relationships

Research into the mechanisms of change between parenting interventions and couple relationship quality suggests that improvements in parenting skills and child behaviour lead to better relationships between parents.

The study, by University of Zurich researchers published in the Journal of Family Psychology, also found that when fathers feel more confident and engaged in parenting, both partners were likely to feel their relationship had improved.

With family breakdown regarded as one of the most central causes of poverty, the research adds to growing evidence that parenting programs have much to offer across a number of policy settings aimed at reducing income inequality and its effects.

Led by Martina Zemp at the School of Psychology at The University of Zurich, the study used data from research published in 2008 to test whether improvements in children’s behaviour after their parents participated in a parenting program could predict better relationship quality for their parents above and beyond the development of better parenting skills.

In the original study, led by Guy Bodenmann from the Institute for Family Research and Counseling at The University of Fribourg, 50 couples were randomly assigned to participate either in Couples Coping Enhancement Training (CCET), Group Triple P or a control group. The research was conducted in Zurich with families of children aged from 2 – 12 years. Researchers followed up with the families a year later.

The original 2008 study found that mothers in the Triple P group showed significant improvements in parenting, parenting self-esteem and a decrease in stressors related to parenting. They also reported significantly lower rates of child misbehaviour than the other two conditions. However, only a few significant results were found for fathers and overall, positive effects of relationship training were somewhat lower than those for Triple P.

In the 2016 study, the authors re-analysed the original data to investigate whether improvements in children’s behaviour were related to better couple relationships for parents.

Links between improved child behaviour and better relationships

The researchers found that mothers who reported improved child problem behaviour a year after participating in Triple P also reported improved couple relationship quality.

“Among fathers, however, it was not their evaluations of improved child problem behaviour, but rather their self-reported improvement of parenting skills which significantly predicted both fathers’ and mothers’ relationship quality at the 1-year follow-up,’’ the authors write.

“None of these effects were apparent in the control group, indicating that the reported findings may not be considered natural processes but likely occurred as a result of parents’ participation in Triple P.’’

So the role of parenting appears to have important implications for the quality of couple relationships, with both parents reporting better relationships when fathers are more actively engaged in child rearing.

In the discussion, lead author Martina Zemp and colleagues explore the idea that fathers may be less sensitive to child problem behaviours than mothers because they spend comparatively less time with their children.

“Studies have generally found that fathers report fewer problem behaviours in children than mothers (Bornstein, 2014),’’ they write. “This circumstance may also contribute to our finding that improvement in child problems did not directly affect fathers’ relationship quality.’’

Parents working together as a team

However, a New Zealand randomised controlled trial which set out to enhance father engagement in Group Triple found that both mothers and fathers reported improvements in disruptive behaviour in their children following the intervention.

Writing in Behaviour Therapy, Tenille Frank and colleagues explain that they decided to involve both parents in the design of the study because of previous findings that improvements in child behaviour are more likely to be maintained over time when both parents take part in a program.

“One reason for these findings is that as both parents get the same message about child behavior management strategies they may be able to support and help each other, leading to greater interparental consistency and lower conflict (Bagner & Eyberg, 2003; Webster-Stratton, 1985),’’ the authors explain.

“Parenting strategies are more likely to be effective when both parents agree on one approach (Arnold, O’Leary, & Edwards, 1997) and implement it consistently (Frick, Christian, & Wootton, 1999.’’

“Children’s positive adjustment has been associated with high-quality co-parenting behaviors, such as teamwork and support for the other parent, lack of conflict over child-rearing, and agreement on child-related topics (Teubert & Pinquart, 2010).’’

So, while children benefit from parents working together as a team, as Frank et al. discovered in the New Zealand trial, it is also evident that “parents who are able to work constructively together as a team on parenting issues are also more satisfied in their close relationship’’ as the Zurich authors write.

As Zemp et al. note in their conclusion: “First they (our findings) suggest that children’s problem behavior may affect the parents’ relationship quality over time. Second, the findings also highlight the possibility that prevention programs that are designed to reduce child problem behaviour may have added value in strengthening the couple’s relationship quality.’’

 

First randomised trial of a parenting program in mainland China shows Group Triple P has a positive impact on children’s academic lives

shutterstock_276608939A paper published in the journal Behavior Modification explores whether the development of more westernised parenting practices in China over the past four decades would mean that western-developed parenting programs would be effective with Chinese families.

The randomised controlled trial of Group Triple P, the first RCT of a western-developed parenting program in mainland China, found that Group Triple P significantly improved dysfunctional parenting and parental adjustment, increased parents’ confidence and reduced child adjustment problems.

The introduction of Triple P to Shanghai parents of children from grades one to three who were worried about their child’s schooling also sought to find out if Triple P could have a positive impact on children’s academic lives.

The findings suggest that may be the case, with participation in Group Triple P leading to parents becoming more satisfied with their child’s academic performance and the children showing less problem behaviours related to learning, according to the parents.

All effects were maintained six months after the parents participated in the program.

Academic performance

Former PhD student of the Parenting and Family Support Centre at The University of Queensland, Dr Mingchun Guo, said that improved parental satisfaction in academic performance may have been brought about because parents had adjusted their expectations of their children and had become more accepting of their academic achievement. Alternatively, there may have been an actual change in the child’s academic achievement.

“Unfortunately, we were not able to measure academic performance directly in this study, although a recent 15-year follow-up study in Western Australia indicated Group Triple P , when delivered to parents of children aged at 3 to 4 years, produced sustained improvements in children’s literacy and numeracy scores once at school.’’

The Chinese study was also a rare attempt to investigate parenting changes from the child’s perspective, with children reporting that their parents used significantly more positive parenting practices after participating in Group Triple P. However, Dr Guo cautioned that more research was needed to explore children’s views on changes in parenting practices.

The study found no change on children’s reports of corporal punishment in the home either at post-intervention or six-month follow-up, however, Dr Guo suggests this may have been caused by a floor effect due to the low average level of corporal punishment reported by parents in the study.

“Triple P encourages nurturing, engaging, consistent, and assertive parenting; hence, it coaches authoritative parenting,’’ Dr Guo writes. “As recent research has shown that Mainland Chinese parents endorse authoritative parenting and this is positively related to children’s social and school adjustment, it is not surprising that Group Triple P had positive effects on a range of parent and child outcomes in this study.’’

In introducing the study, Dr Guo places parenting in the context of the drastic changes in economy, education, family structure and family lives that China has experienced in the past four decades.

Confucian philosophy and filial piety

He said Confucian philosophy and values such as filial piety, or respect for one’s parents, had played a major role in Chinese parenting practices with Chinese parents typically depicted as emphasising the need for parental authority and obedience from children.

But such attitudes may have relaxed to some extent with suggestions that the one-child policy, for example, had led to Mainland Chinese parents becoming more indulgent with their children.

A recent empirical study also found that Mainland Chinese parents predominantly endorsed authoritative rather than authoritarian parenting, they emphasized egalitarian and the two-way parent-child relationship and were warmth-oriented rather than control-oriented toward their children.

Dr Guo writes that these findings on parenting styles were substantially different than those found in studies conducted one and two decades previously, suggesting Chinese parenting practices had become more similar to Western-style parenting.

In this context, it was likely that Mainland Chinese parents, particularly those in urban areas, would accept and use parenting strategies from a Western-developed program. This particular trial suggests that this may well be the case.

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.

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.

 

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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Japanese researcher’s background as a nurse eventually leads her to publish on Triple P

Dr Rie Wakimizu

Dr Rie Wakimizu

Dr Rie Wakimizu is an Associate Professor from the University of Tsukuba in Japan.

She was part of an interdisciplinary group whose study on the effects of Group Triple P for families raising preschool or school-aged children with developmental disabilities adds to the growing Triple P evidence base in Japan.

In this translated version, Dr Wakimizu explains what prompted her interest in helping children with developmental disorders and their families.

During my two years nursing in a paediatric ward, I looked after a child with a developmental disorder who also suffered from malignant tumours.

The child’s mother was a single mother with severe depression. The patient’s sibling was neglected and then went on to develop problems such as refusing to go to school.

It was because of this case that I became really interested in interventions for children with developmental disorders and their families.

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