For positive parenting read also positive practice

4 February 2009

Triple P originator Matt Sanderss visit to Birmingham, one of the programs key UK pilot sites, has coincided with the publication by the Childrens Society of a report, which, rather as a UNICEF report did two years ago, points to the relatively poor state of UK childrens well-being among Western nations.

The Childrens Society has urged UK policy makers, practitioners and the population at large to consider how parents might be contributing to their childrens difficulties and how they might do better. One of their recommendations wide, easy access to parenting supports is a fundamental principle of Triple P.

Matt Sanders advocates a public health approach, which means reaching far more parents than traditional programs manage. He wants it to be regarded as normal and unremarkable for people to seek help with parenting skills.

The sort of scale of response such a cultural change would require presents childrens services with big challenges, and when he talks to large groups of practitioners, as he did in Birmingham yesterday, part of the mission is to encourage them to see how the hurdles to universal good practice can be overcome.

Triple P is able to boast a large and increasing evidence base. Sanders was involved in the majority of the early evaluations but, as the popularity of the program has spread across 18 countries, independent assessments have become more common. There have been over 90 studies, half of them randomized controlled trials.

Evaluation has gone beyond establishing whether the program improves childrens emotional well-being and behavior to explore implementation issues, for example, whether parents prefer to receive help through home visits, groups or via the web and television (they much prefer the latter).

To cope with large-scale roll-out, he promotes the idea of "Triple P champions" who challenge their organizations to provide the right structures and support for staff to deliver the program well and cost effectively.

Contrarily, some paid for their staff to attend training events but then did not give them the opportunity to use their training to run the programs, he said.

Parenting support must not become the prerogative of a particular discipline. Organizations should work together on implementation, adhering, he suggested, to formal written undertakings to train a certain number of staff and deliver an agreed number of programs. Everyones business but no-ones responsibility was a snare to be avoided.

For Triple P to be delivered well practitioners themselves needed support, most obviously in the shape of good line management and supervision. But just as self-regulation was a key aspect of management (enabling individuals to set their own goals, evaluate their own achievement and develop confidence on their own abilities), so supervision should be less about scrutiny than peer support.

Local peer support networks existed to encourage practitioners to reflect on cases and discuss challenge; clinical consultation days were provided by Triple P International (the company that supports dissemination and training).

Webinars and online networks for program providers and coordinators rested on Triple P manuals which prescribed the length, content and frequency of sessions. The sheer volume of Triple P support sometimes led to a misperception that practitioners had no scope for making adaptations.

On the contrary, he explained, Triple P allowed for and encouraged practitioners to use the materials flexibly, for example by tailoring examples to the particular needs of parents.

There were however core elements that would dilute the impact of the program if they were omitted. Practitioner training and support structures helped people to recognize what could be changed and what should be left well alone.

In similar vein, Triple P worked at five levels of increasing intensity, and there was a normal expectation that the more complex the case the more intensive the intervention. However, in a proportion of complex cases, elegant, brief interventions could be just as powerful.

There was an underlying commitment to "minimal sufficiency": parents should be offered the minimum amount of input they needed be it a single face-to-face session or an eight week group program. They were often the best judges of what would benefit them, he argued.

Rather than viewing the press as a beast to be kept at bay, Sanders regards the media as an essential component of the public health approach. He does a weekly slot on local radio in Brisbane where parents can phone in with their parenting concerns and he makes regular contributions to the local paper and television.

He also advocates building relationships with politicians. He spoke of inviting elected members to attend the final session of a parenting group so that they could hear the personal testimonials of parents. Not only did such meeting provide a good photo opportunity but they gave politicians a story to help them communicate the benefits of parenting support.

Tuesdays seminar was one of a series hosted by Birmingham City Council for the childrens services workforce. They are part of the citys Brighter Futures strategy a ten year plan for childrens services that puts evidence based program center stage.

Cheryl Hopkins, the Service Director leading the implementation of Brighter Futures, describes it as a a portfolio of programs around prevention, early intervention and treatment, of which Triple P is one.