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Home-visiting program plus Triple P shows significant improvements for children’s early cognitive development

Cute Toddler Child - 3

One of the most extensively conducted randomised controlled trials of an early childhood intervention program in Europe has shown that a home visiting program combined with the Triple P – Positive Parenting Program improved children’s cognitive development.

Results of a University College Dublin evaluation of the Preparing for life program include a finding that children in the high treatment group whose families participated in the full intervention had a 10-point IQ gap over children in the low treatment group.

Previous evidence of positive impacts of home visiting programs on children’s cognitive development before starting school has been limited.

As the study’s evaluation report states:

Only a small number of studies have found favourable intervention effects during the early years . .  However, the results are mixed and there is much variation in the effect sizes found by different programmes (Filene et al., 2013).

Preparing for Life (PFL) is a community-led initiative operated by the Northside Partnership in North Dublin and was evaluated over a seven-year period by the UCD Geary Institute under the direction of Dr Orla Doyle, an economist who has been awarded the Barrington Medal for her work in the economic and social sciences.

More than 200 families in designated disadvantaged areas of Dublin were involved in the trial, with the program aiming to help parents develop skills to help their children in five domains of school readiness:

  • cognitive development
  • physical health and motor skills
  • social, emotional & behavioural development
  • approaches to learning
  • language development and literacy

Parenting and Family Support Centre director and Professor of Clinical Psychology, Professor Matt Sanders, said PFL home-visiting mentors were trained to offer parents information about parenting and child development over a period of five years. They were also trained to deliver Triple P.

“Consequently, the principles and techniques of Triple P influenced the way in which mentors encouraged parents to interact with their children,” Professor Sanders said.

Access to a baby massage program was also available as well as access to additional Triple P programmes, such as Group Triple P.

The home visits started with mothers during pregnancy at 21 weeks and continued until the child started school at age four or five.

As part of the trial, a high treatment group received the full intervention, compared to a low-treatment group which did not receive the mentoring program, additional Triple P access or the baby massage program.

According to the final evaluation report, by school entry, the PFL program had a significant and large impact on children’s cognitive development. Children who received the high treatment supports had better general cognitive functioning, spatial abilities, non-verbal reasoning skills, and basic numeracy skills. This means that they were better at understanding information, seeing patterns, solving problems, and working with numbers.

 

overall-cognitive-development

Major impacts when the children were at school entry age included:

  • children in the high treatment group had a 10 point IQ gap over children in the low treatment group
  • 25 per cent of high treatment children had above-average verbal ability, compared to eight  per cent of low treatment children
  • High treatment children were better able to control their attention
  • 25 per cent of high treatment children were not on track in their social competence compared to 43 per cent of low treatment children
  • High treatment children had better gross and fine motor skills

More specifically, the program was shown to have a significant and large impact on:

  • Children’s overall verbal ability
  • Expressive and receptive language skills
  • Communication and emerging literacy skills

verbal-ability

PFL had some impact on how children approached learning. Children who received the high treatment supports were better able to manage their attention.

PFL had a significant impact on:

  • Reducing children’s hyperactivity
  • Reducing inattentive behaviours
  • Improving social competencies and autonomy

 

approached-learning

The program had a significant impact on reducing the amount of hospital services the children used and improved how families used these services. And children in the high treatment group were less likely to:

  • Visit the hospital for urgent reasons
  • Experience fractures
  • Visit the orthopaedics, physiotherapy, paediatrics, ocular and plastic surgery outpatient departments

 

hospital-services

 

PFL also had a significant impact on

  • Children’s gross motor skills
  • Children’s fine motor skills
  • Physical independence

(Graphics used in this blog post have been sourced with permission from the final evaluation of Preparing for life by University of College Dublin’s Geary Institute.)

Delivering a population rollout of the Triple P – Positive Parenting Program takes planning and commitment. But help is available. And the rewards are strong outcomes and sustained delivery

The team behind the successful rollout of the Triple P – Positive Parenting Program in the Irish Midlands has put its experiences into an implementation guide for other organisations wanting to improve the quality of life for children and parents at a population level.

The guide, Getting Started – Getting Better, sets out to help agencies considering implementing Triple P’s population health approach.

The Triple P multi-level system of parenting programs was delivered community-wide in the Irish Midlands by the Midlands Area Parenting Partnership (MAPP), which included representatives from the Irish Health Services Executive as well as community organisations. You can read about the evaluation of the project, funded by Atlantic Philanthropies, here.

That 2014 evaluation determined that a number of health outcomes for children and parents changed at the population level, including a 37.5 per cent drop in the numbers of children experiencing clinically elevated levels of social, emotional and behavioural problems.

When organisations such as MAPP and others around the world get it right, everyone wants to know the secret. With that in mind, the team behind MAPP have collected their experiences into a guide suitable for organisations with similar levels of capacity. It sets out to help organisations navigate what can often be the tricky process of embedding a system of evidence-based programs into a sustained delivery model that is implemented with fidelity.

Triple P founder and director of the Parenting and Family Support Centre at The University of Queensland, Professor Matt Sanders, described MAPP as a group which had valued the Triple P population approach from the start. MAPP had developed their own organisational structures to ensure the Triple P system was implemented with fidelity and quality assurance mechanisms were built in.

“MAPP understood from the outset the importance of building in local evaluations of evidence-based programs to ensure quality delivery. They learnt how to adapt to change and continue working on the sustained delivery of the program,’’ Professor Sanders said.

Best-practice example of organisational self-regulation

Professor Sanders described MAPP’s delivery of the Triple P system as a best-practice example of organisational self-regulation at work, to the extent that MAPP had designed their own system of implementation and evaluation to ensure the outcomes they were seeking for children and families were achieved.

“The principal of self-regulation and minimal sufficiency lies at the heart of the behaviour change model inherent in the Triple P – Positive Parenting Program and it’s always great to see this tenet at work with parents and children and practitioners. This is a great example of self-regulation and minimal sufficiency at work at an organisational level,’’ Professor Sanders said.

Around the same time as the MAPP rollout, The University of Queensland’s commercial partner in the worldwide delivery of Triple P, Triple P International (TPI), began to develop an Implementation Framework to create a way for TPI to support organisations in the delivery of Triple P, depending on the needs of the delivery organisation.

The story of how the TPI Implementation Framework was developed, the research and program delivery experience it was built on, and how it works to support organisations delivering Triple P has just been published in high-impact journal Prevention Science.

The Triple P Implementation Framework: The Role of Purveyors in the Implementation and Sustainability of Evidence-based Programs explains that while organisations are encouraged and supported to become independent problem solvers to overcome implementation obstacles (self-regulation), they are also supported from the outset by TPI Implementation Consultants. These consultants provide a level of support adjustable to the often differing levels of need of delivery organisations (minimal sufficiency).

Author of the Prevention Science article, Jenna McWilliam, described MAPP as a best-practice example of an organisation which had required a relatively minimal level of implementation support from TPI.

“The development of the Implementation Framework was prompted by feedback from organisations faced with challenges implementing Triple P, such as understanding the particular needs of implementing Triple P in the adoption phase and how to effectively sustain implementation,’’ Ms McWilliam said.

“It’s always extremely encouraging to see organisations understanding the model behind Triple P and applying it in various ways around the world,’’ Professor Sanders said. “They are taking the evidence and making it their own. We can only encourage and applaud such organisations while endeavouring to do everything we can to support others to implement the Triple P system.’’

 

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.

falkirk pic

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

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

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

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

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