Triple P gets airborne in Tokyo trial

The “airworthiness” in other cultural contexts of evidence-based programs designed in North America, Europe and Australasia is being given a valuable test in Japan where the Triple P parenting program is being trialed.

Program designer Matt Sanders has devised a staged approach for the Japanese context, working with colleagues Yuki Matsumoto and Kate Sofronoff from Triple P’s home in Queensland, and Noriko Kato from the National Institute of Public Health in Japan.

Their experience adds a new dimension to what is known about the effectiveness and efficacy of Triple-P and also gives an insight into the some of the characteristics of Japanese society.

The starting point was finding out whether the program would be acceptable to Japanese parents. Ingeniously, the team began their investigation not in Japan but among Japanese parents living in Australia.

A randomized controlled trial there involving 50 parents demonstrated the reduction in conflict and improvement in child-raising competence that are claimed as hallmarks of Triple-P’s success.

More importantly, the initial study indicated high levels of parental satisfaction with the program. It gave participants the quality of service they expected and the type of help they were looking for.

As the evaluators acknowledge, some of the families were headed by non-Japanese parents and most were well educated. But there were enough signs of success to give the researchers confidence in the potential of the Japanese trial.

A survey of 222 Japanese parents estimated the likely level of take-up. It was followed by the randomized allocation of 54 families to Triple P or a waiting list. The parents were college educated living in the Tokyo metropolitan area with children between the ages of two and ten.

Leaving aside the questions that must arise from the size and nature of the sample, here, too, the results were promising enough to make a case for extending the service.

The progress of the study also shed light on the wider potential for prevention initiatives. Japanese parents in Japan and Australia were enthusiastic about those parts of Triple P that encouraged “descriptive praise” of their children, sharing affection and family conversation. There was less support for strategies such as “time out” used in Australia and North America.

The research seems to support evidence that portrays Japanese parents as being typically warm and engaging. They do not take easily to an authoritarian approach to parenting.

The project also points to the difficulties of establishing prevention programs in the mainstream. State structures do not lend themselves to models like Triple P.

In the Japanese experiments, the program was delivered via a non-governmental organization working in the community with a trained pediatrician, psychologist and health promotion professional. This approach was effective in the set-up phase, but would not be suitable were the project to be taken to scale.

Nearly all of the Tokyo parents completed Triple P. But fewer responded to requests for follow-up data. Japanese fathers frequently move for their work, causing problems for the continuity of prevention efforts.

As with any innovation, the story is one of progress, mixed with unanticipated challenges. But understanding the careful translation of Triple P into Japanese society should help others contemplating transporting proven models to untried conditions.

To return to the airport metaphor: the runway lights have been lit. It remains to be seen how many programs from North America, Europe and Australasia will be guided to Japanese soil.

References

Ishidu H, Mashiko M, Fujiu M, Kato N, & Shiozawa S (2008). ‘An intervention study on Positive Parenting Program (Triple P)’, Journal of Child Health, 67, pp. 487-495.

Matsumoto Y, Sofronoff K, & Sanders M, ‘The efficacy and acceptability of the Triple-P parenting program with Japanese parents’, Behavior Change, 24, 4, pp. 205-218

Matsumoto Y, Sofronoff K, & Sanders M (2009), ‘Socio-ecological predictor model of parental intention to participate in Triple-P positive parenting program’, Journal of Child and Family Studies (forthcoming)