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

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

Ron Prinz

Professor Ron Prinz

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

San Diego delivery of Triple P a powerful illustration of how a population approach can work

An evaluation of the delivery of the Jewish Family Service of San Diego’s Positive Parenting Program in a low-income, Spanish-speaking community is a powerful illustration of how a population approach can improve the lives of children and their families, Triple P founder, Professor Matt Sanders, says.

jfs logoThe Triple P – Positive Parenting Program was chosen by the County of San Diego to promote social and emotional wellness for children and families living in at-risk, low socio-economic communities with a high concentration of ethnic minorities.

The County provided Jewish Family Service with a Mental Health Services Act Prevention and Early Intervention Grant to provide Levels 2, 3 and 4 of Triple P through the delivery of Triple P Seminars, Individual (Primary Care Triple P) and Group Triple P.

JFS conducts regular evaluations of its implementation of Triple P. In 2013-14, its evaluation showed significant improvements for the majority of parents and children who participated in the program.

While change occurred across a range of child and parent outcomes, the largest improvements came following Group Triple P for children in the clinical range for conduct problems and social, emotional and behavioural concerns, and for parents’ whose self-reports placed them at clinical levels of depression. In both examples, most parents and children in the clinical range moved into the normal range.

Triple P founder, Professor of Clinical Psychology and Director of The University of Queensland’s Parenting and Family Support Centre, Matt Sanders, said the fact that JFS was able to reach such large numbers of families and record extremely high rates of program completion and satisfaction in a predominantly low-income, Spanish-speaking community was extremely rewarding to see.

“The JFS implementation model demonstrates just what can be achieved by following good practice in program delivery,’’ Professor Sanders said.

“It shows that quality parent education can benefit all cultures and economic environments. Parents have a universal need for support and this evaluation shows those needs can be met and that barriers to services can be addressed by dedication and creativity.’’

Mandate for early intervention and prevention support

Director of Positive Parenting for JFS in San Diego, Lea Bush, said the Triple P mix of light-touch seminars combined with more intensive programs for families with greater levels of need provided an ideal way for JFS to fulfill its mandate to provide early intervention and prevention support services for families across the targeted population.

The JFS evaluation, conducted by consultant Susan Hedges, shows uniformly large effect sizes for children in the clinical range of social, emotional and behavioural problems with the majority of these children moving into the normal range after their parents participated in Group Triple P.

From this group of families, of the 86 children assessed to be in the abnormal range for conduct problems, 74 per cent (or 64 children) improved following Group Triple P, with 63 per cent (54 children) moving into the normal range. Similar levels of improvement were recorded for children with abnormal levels of emotional problems (76 and 60 per cent), hyperactivity (88 and 81 per cent), peer relationship problems (72 and 51 per cent) and total difficulties (88 and 70 per cent).

Replicating clinical trial results, JFS parents’ depressive symptoms improved following Group Triple P across a range of functioning from mild to severe. Eighty-two per cent of parents with mild to moderate levels of depression moved to the normal range, while 67 per cent of parents with severe to extremely severe depression moved to the normal range.

High retention rates of parents

The evaluation also shows high retention rates of parents across the range of Triple P programs delivered with very high levels of parent satisfaction.

Ms Bush said the delivery of Triple P Seminars in elementary and pre-schools across San Diego provided an ideal initial access point into the community.

“Parents really enjoy the low-barrier, easy engagement model of Triple P Seminars because there are not too many expectations placed on them to participate or interact,’’ Ms Bush said. “We provide seminars directly at preschool and elementary school sites and ask that parents attend all three sessions of the seminar series to receive a ‘completion certificate’.

“As needed or desired by parents, we then enrol families from Level 2 into Level 4 Group or Level 3 Individual programs. It works very well because parents learn in the seminars that this is a safe place to learn about ways to improve their children’s behavior and they develop trust and rapport with other members of the preschool or community. They then become more willing to engage in higher levels of service when necessary.’’

Over the 12-month period, JFS Parent Educators delivered to 2831 parents or other individuals such as school or child care staff who attended at least one session of Triple P. At least 3500 children were estimated as benefitting.

Since 2009, Triple P has reached an estimated 10,262 adults in San Diego, benefitting an around 19,972 children in the County.

A vast number of sites are served by the JFS program annually, with more than 100 sites reached each year for the past two years, including Head Start centers.

Ms Bush said the organisation went to great lengths to remove any potential barriers to parents attending programs, providing incentives ranging from free babysitting, snacks, laundry soap, transportation and children’s books.

“Our parent education staff are really empowered to make relationships directly with the sites they serve, so they get to know the staff, the parents, the teachers and use those relationships to compel attendance by as many parents as possible,’’ Ms Bush said.

“All our staff are what we call “para-professional” or “peer-based” staff who were hired for their ability to connect with the community. This is another hallmark of how we are able to develop rapport.’’

Copies of the report are available upon request from Ms Bush, Director of Positive Parenting at Jewish Family Service of San Diego, leab@jfssd.org

matt masterclass brighton

Uplifting, gratifying and professionally rewarding: Triple P Masterclasses in the UK, Ireland and Germany show that the program is in good hands

For someone who grew up in a boys school famous for turning out All Blacks, last weekend’s Rugby World Cup final was a personal highlight of my recent trip to the United Kingdom.

But the professional highlight would have to be the Masterclasses I felt privileged to deliver to Triple P practitioners around the UK, Ireland and in Berlin over the past few weeks.

The energy in the rooms for individual Masterclasses might not have matched Twickenham Stadium with 80,000 fans for the final, but for me collectively they came close.

If participating in Masterclasses is like taking the pulse of Triple P implementation in the community, then the program is in great hands.

There were strong numbers at the masterclasses, such as in Brighton, pictured above. Of course, this is personally satisfying but strong attendance also signals that good local implementation of Triple P is in place, that practitioners value the program and obviously see a great fit for the families they’re seeking to help.

Many of the practitioners who came to the Masterclasses are achieving outstanding outcomes with some very complex families.

We had some excellent question and answer sessions where practitioners had the opportunity to ask me the most difficult clinical questions they could think of.

Working with complex families

These questions certainly kept me on my toes and highlighted once again the extremely diverse ways that organisations and practitioners are using Triple P to help a great range of families, such as parents in prison, families with complex mental health problems and those with learning disabilities.

In Germany, there was intense interest for the German version of Triple P Online.

During meetings I tried to convey the immense value to communities in having a well-trained and supported workforce to deliver evidence-based practices such as Triple P.

It was also great to see the team from Falkirk, pictured below, with their award for Triple P delivery and use of the Peer Assisted Supervision and Support (PASS) implementation model.

PASS draws on Triple P’s self-regulatory model and draws support from the use of peers rather than expert mentoring. The idea is to empower practitioners and increase sustainability of program delivery within organisations.

Triple P and the Psychology of Parenting Project in Scotland

Falkirk was one of the pilot sites for the Psychology of Parenting Project, which has embedded the delivery of Triple P and The Incredible Years programs within a suite of complementary training activities and organisational supports throughout Scotland.

Thanks to everyone involved for making my Masterclass series such an enjoyable and professional rewarding experience.

Hopefully more local authorities will see the true value of adopting the full multilevel system of Triple P within a public health framework.

falkirk pic

‘We need to turn wishful thinking to help the lives of children into a public funding priority to support the skills of parents’

In a world where the well-being of children is a priority, preparing for parenting would become something people aspire to, not something associated with stigma, Professor Matt Sanders, founder of the Triple P – Positive Parenting Program, told delegates at this year’s Helping Families Change Conference in The Netherlands.

In such a world, evidence-based parenting programs would become a policy priority for governments and be funded accordingly because parents had demanded that it be so.

“The single most important thing we as a community we can do to promote the well-being of children and reduce child maltreatment is to increase the skills, confidence and competence of parents at a whole-of-population level,’’ Professor Sanders said in his keynote address to the 17th annual HFCC at the historic Beurs Van Berlage building in the heart of Amsterdam.

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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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