Triple P makes the big leap

Triple P makes the big leap
15 July 2008

Some parenting initiatives have proved they have the potential to reduce bad behavior among target groups of children. But the science of scaling up the effort to create effective public health measures for the benefit of the general population is in its infancy.

Now research from Australia just published in the Journal of Primary Prevention suggests a confident step into that bigger arena for Triple P and its creator Matt Sanders, Professor of Clinical Psychology and Director of the Parenting and Family Support Centre at the University of Queensland.

Re-branded for the statewide Australian experiment as the
Every Family initiative, all five levels of the intervention have been delivered simultaneously over a period of two years to families in Brisbane.

The University of Queensland project, which puts Sanders in the slender vanguard of prevention scientists who have implemented an evidence-based parenting program at population level, was given political impetus by disquieting findings emerging from household surveys of Australian parenting practice.

The research suggested that one in four children under the age of 12 had a clinically significant behavioral or emotional problem. It also indicated that disconcertingly high numbers of parents were resorting to practices that research has shown to be not only ineffective but also likely to aggravate any behavioral or emotional problems in their children.

Bad practices included smacking, shouting and frequently getting angry. Parents who reported being prone to such common frailties tended to be the same ones who said they felt less confident about parenting and found it stressful and demanding. It is just such an accumulation of risk factors in family life that Triple P has been shown to alleviate.

The decision to take action population-wide involved entering into partnership with beyondblue, an independent, Australian, not-for-profit organization set up to combat depression, anxiety and related substance misuse disorders.

Sanders and his Queensland team ran the experiment in three cities. Families in ten areas of Brisbane received the intervention; equivalent families in five areas of Sydney and five areas of Melbourne received care as usual and acted as the control group.

To measure the results over 6,000 surveys were conducted with parents and children in randomly selected households between July 2003 and April 2006. The extent of children’s fluctuating emotional and behavioral difficulties was monitored using Goodman’s Strengths and Difficulties Questionnaire. Information was also collected on parents' mental health and parenting practices.

Compared to the care-as-usual group, the Brisbane families who received Triple P experienced significant reductions in psychosocial difficulties and emotional problems. This finding applied both to children and adults. Significant reductions in parental depression and in coercive parenting were also observed among the intervention households.

However, the intervention did not have any more significant effect on children’s behavior, prompting the team to consider what might have been common to the experience of the experimental and control groups that could have had an impact on psychosocial and emotional difficulties.

For example, every family was exposed to a media and community education campaign involving newspapers, radio stations, television and websites broadcasting messages about positive parenting to the mass population.

The campaign also publicized the behavioral and emotional problems common to children and families in Australia alongside information about the value of positive parenting. Advice and support included a telephone helpline.

The program developers concluded that the publicity was enough by itself to improve the quality of parenting generally and that it had the side-effect of de-stigmatizing requests for help. It also raised the profile of the program, so encouraging more families to take up the more intensive services on offer.

Sanders notes that effecting behavior change might require the more intensive support provided in Triple P group sessions rather than a universal media campaign. Previous RCT evaluations of Triple P have shown repeatedly that intensive levels of the program have markedly positive effects on behavior.

The cost benefit equation is also promising. The Queensland researchers say Triple P components can be built into existing services and delivered by a variety of professionals across traditional agency boundaries. In Brisbane, the media were persuaded to run the marketing campaign for very little cost, to the greater good of local families.

[See also: Accentuating the positives with a Triple P.]

Reference
Sanders M, Ralph A, Sofronoff K, Gardiner P, Thompson R, Dwyer S, Bidwell K. (2008) “Every Family: A Population Approach to Reducing Behavioral and Emotional Problems in Children Making the Transition to School”, Journal of Primary Prevention, 29, pp197-222.

Explainers

Triple P

Triple P is a parenting program designed to improve outcomes for children up to the age of 16. Developed over 25 years at the University of Queensland in Australia, it includes public health-style preventative strategies with the potential to reach all children and their families, as well as offering early interventions and treatments for children with specified problems.
The program is also available in a wide range of formats intended to accommodate families and communities with different needs and preferences as to the type, intensity and the mode of assistance they require (for example, families living in urban or rural areas). It seeks to prevent severe behavioral, emotional and developmental problems by improving the knowledge, skills and confidence of parents.

Matthew Sanders

Matthew Sanders is Professor of Clinical Psychology and Director of the Parenting and Family Support Centre at the University of Queensland, Australia where he created the Triple P Positive Parenting Program. The Parenting and Family Support Centre has undertaken a number of experimental evaluations of family-based interventions for children. His work on prevention has been widely used by policy makers in Australia and Europe.

public health

Public health approaches seek to prevent impairments to health and development by changing the behavior or exposure to risks of a specified population. Examples include immunization programs which, if accepted by a sufficient proportion of the population, will provide protection against exposure to disease. In social contexts, the effectiveness of public health approaches often depends on people wanting to behave like other people. For example, a public health approach might seek to reduce the amount of alcohol consumed by the average drinker, on the assumption that consumption among heavier drinkers will follow suit.

Strengths and Difficulties Questionnaire (SDQ)

The Strengths and Difficulties Questionnaire is a short screening questionnaire for children aged three to 16 years that gives reliable information on emotional health, conduct problems, hyperactivity, peer relationship problems and pro social behavior. Also known after its originator as Goodman's SDQ, the instrument exists in several versions to meet the needs of researchers and clinicians, and has been published in over 50 languages. An impact supplement asks parents, teachers or the child about chronicity, distress, social impairment, and burden to others if a mental health problem exists. Some applications also ask two follow-up questions "Has the intervention reduced problems?" and "Has the intervention helped in other ways, for example by making the problems more bearable?"

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