Your SlideShare is downloading. ×
0
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Triple P Metzler 12-3-2010
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Triple P Metzler 12-3-2010

449

Published on

Powerpoint presentation from Carol Metzler. Presented at the 2010 Research to Practice Conference

Powerpoint presentation from Carol Metzler. Presented at the 2010 Research to Practice Conference

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
449
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
12
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Parenting matters. So important to support parents in raising healthy children. The quality of the parenting that children receive really matters and it affects every aspect of their development.There is a reasonably high prevalence of children’s behavior disorders; it currently stands at about 18% of children.When children have difficulties with behavior problems when they are young, coupled with poor family relationships and dysfunctional parenting practices, the children are much more likely to grow up continuing to have problems with the law, substance use, and poor functioning and poor health as an adolescent and adult.
  • Thanks to Matt Sanders of University of Queensland for this slide.
  • We know that parenting programs that have undergone rigorous evaluation and are evidence-based can make a substantial difference in families’ lives.
  • More intensive, in situ
  • So, there are a number of evidence-based parenting interventions, and that’s great.Most parents struggle from time to time with difficult child behaviors and could use some help…Challenges re: recruitment and retention: Scheduling conflicts, logistical difficulties, fatigue, insufficient motivation to get out, not wanting to join a group.
  • So we need to think about this in a whole new way.The goal of a public health approach to improving parenting is to achieve positive changes in parenting practices across a whole population, thereby reducing the prevalence of socioemotional and behavioral problems in children. (Prevalence means the percentage of a population with a particular problem or characteristic.)A public health framework gets us thinking bigger.
  • Focus today on two aspects of the RE-AIM formula that undergird the public health approach: Reach and efficacy.
  • Understand the principles of maximizing program reach through a using a variety of appealing delivery formats and agents, and increasingefficiency of delivery…and maximizing efficacy through adapting to different levels of families’ needs and promoting parental self-regulation.Public health perspective requires us to look for efficient ways to meet a diverse range of needs among a diverse range families through a variety of delivery formats.
  • Can organize these formats into varying levels of intensity to meet varying levels of need.Not everyone needs a 12-session parenting group or a full course of meetings with a therapist. Some parents can benefit from a lighter dose – a brief consultation, a workshop, a self-administered course, an online program, etc.
  • 158 ethnically diverse parents of 3-6 year olds, half with clinical levels of behavior problems, and half within normal range.In this sample, the most common approaches that our field offers are least preferred by parents. Hmmm.Pattern is also consistent for mothers vs. fathers, and Caucasians vs. minorities. Consistent preference for self-administered approaches across subgroups.
  • Not JUST about individual families one at a time, but ALSO about affecting the entire community
  • 20 countries, 18 languages, 4 continents: N. America, Australia, Europe, AsiaDifferent levels of intensity for different levels of need.
  • 17 core parenting strategies presented
  • Natural touchpoints for parents
  • Standard – core program – is designed for dealing with children’s conduct problems
  • Entire counties in South Carolina
  • Positive, substantial, sustained effects of non-traditional, non-clinical formatsClinical cut-off = 132
  • Preliminary results of pilot studyECBI intensityN (Internet) = 24; N (Waitlist) = 32; intervention effect sig. p<.001, d=1.49
  • The Triple P Parenting Media Study is testing the efficacy of a 10-episode video media series on parenting Content is derived from the Triple P Positive Parenting ProgramResearch sites: Eugene and Portland, OregonSample: 300 parents having difficulty handling their 3-6 year old children’s behavior problems and not otherwise receiving parenting support servicesPreliminary analyses on the first 209 participants also suggest that the Triple P Media Series actually helped parents. Significant Tx vs. WL at T2; ES = .53SignificantTx vs. WL at T3; ES = .62Scale range: 36 – 252 Clinical cutoff: 132Effects for both mothers and fathers on dysfunctional parenting practices and parenting knowledge
  • Underscore the importance of meeting the needs of diverse families – --different income levels--different racial/ethnic groups--different degrees of family risk and difficultiesDennis Embry will help us think outside the box about how we can use a variety of resources and approaches to meet family needs.And Mark Eddy/Laura Rains will discuss methods for matching intensity of treatment to different levels of need.Betsy Davis will discuss issues related to meeting the needs of culturally diverse families.
  • A few words about appeal and engagement from our Parenting Media study. Our goal was to create a program that is more entertaining than your standard instructional video, and more instructional than reality TV, such as Nanny 911 or Supernanny.Hosted format. We use footage of real families in real situations; compelling, dramatic, emotionally evocative and engaging footage; vox pops (that is, person on the street interviews); a parent group with Matt Sanders; and what we call “hero” families who we follow through an episode to see their struggles and successes.Families from the US, Australia, and United Kingdom. American host/narrator. Diversity of families, faces, and accents.
  • These preliminary analyses suggest that the challenges of parenting are universal, across racial/ethnic, income, and educational groups– what is important is that we develop programs that are responsive to people’s felt need for help. The Triple P Media Series was most attractive and useful to those who needed it the most.
  • Transcript

    • 1. A Public Health Approach to Improving Parenting Practices: An Overview of Principles and Practices for Meeting Diverse Family Needs
      Carol W. Metzler, Oregon Research Institute
      carolm@ori.org
      ORI Research To Practice Conference, December 2010
    • 2. The need for effective parenting interventions
      The importance of supporting parents in raising healthy and successful children
      Prevalence of children’s behavior disorders: 18%
      Dysfunctional parenting practices
      & family relationships
      Poor prognosis for long-
      term trajectory, including
      health outcomes as adults
    • 3. Parenting affects many important developmental outcomes
      Parental influence is pervasive
      Language, communication
      Sustained attention and problem solving
      Social skills and peer relationships
      Physical health and well being
      Brain injury and adverse effects of exposure to violence
      Emotion regulation
      School achievement
      Reduced social, emotional, behavioral, and health problems
    • 4. Problem behaviors develop over time
      By age 6: aggressive behavior, difficulty managing strong feelings, weak academic skills
      Elementary school years: academic difficulties, poor bonding to school, rejection by peers
      By early adolescence: drift toward other troubled peers, experimentation with problem behaviors
      The earlier these problems begin, the more chronic and serious they become throughout adolescence
    • 5. Problem behaviors are COSTLY
    • 6. How can we reduce these problems and raise successful children and youth?
    • 7. Promote positive parenting usingevidence-based prevention and treatment practices
    • 8. Positive parenting involves…
      • A safe, engaging environment
      • 9. A positive learning environment
      • 10. Warm, nurturing interactions
      • 11. Assertive discipline – clear, fair, consistent, proactive
      • 12. Realistic expectations
      • 13. Parents’ self-care
    • Why evidence-based practices?
      Our best bet is on programs that have shown positive benefits in experimental evaluations
      Supported by data, not just based on theory
      Rigorously tested and shown to be more effective than “usual care” or an alternative practice
      Can be reproduced in other settings
      Increases our confidence in the results
    • 14. The need for effective parenting interventions
      Evidence-based parenting programs make a difference
      More skillful parents
      Healthier family relationships
      Decreased behavior problems in children and youth
      Improved social skills and academic outcomes
      Improved health outcomes as adults
    • 15. Evidence-based models of family interventions for childhood problems
      Parent education and training
      Examples:
      PMTO, Triple P, Incredible Years, Strengthening Families 10-14
      Skills focused, strengths based
      Warm, positive parent-child interactions and relationship
      Encourage and reinforce desirable behavior
      Monitor children’s activities
      Set clear limits on problem behaviors, and consistently enforce them with fair, non-harsh consequences
      Effective problem-solving
      Generalize skills to new situations
    • 16. Evidence-based models of family interventions for childhood problems
      Home visiting
      Examples:
      Nurse-Family Partnership, Healthy Families New York
      Skills focused, strengths based
      Warm, positive parent-child interactions and relationship
      Parenting education
      Information on child development
      Social support
      Link family with community resources
    • 17. Evidence-based models of family interventions for childhood problems
      Family therapy
      Examples:
      Functional Family Therapy, Multisystemic Therapy
      Skills focused, strengths based
      Promote warm, positive family interactions and relationships
      Promote a relational understanding of problem behavior
      Improve parenting skills
      Improve family communication, problem solving
      Generalize skills to new situations
      Discourage contact with deviant peers
      Link family with community resources
    • 18. The challenge of reaching parents with effective parenting interventions
      Most parents struggle from time to time with difficult child behaviors
      Despite effectiveness, few parents participate in evidence-based parenting programs (Sanders et al., 2007)
      Limited availability outside of major metropolitan areas (Connell et al., 1998)
      Poor participation – substantial challenges in recruiting and retaining parents (Spoth & Redmond, 2000)
    • 19. Limited reach of evidence-based parenting programs
      Limited availability + poor participation = limited reach
      Thus, most parents who could benefit from parenting assistance never receive it
    • 20. The goal of a public health approach to improving parenting
      Achieve positive changes in parenting practices across a whole population
      Reduce the prevalence of socioemotional and behavioral problems in children
    • 21. A public health approach to improving parenting
      To significantly improve the health and well being of children at a population level, we must strengthen parents’ skills, knowledge, and confidence in the task of raising their children
      A public health approach requires us to think about how we can get effective parenting supports to the maximum number of people.
    • 22. How can we achieve a population level effect?
      Create leverage using the RE-AIM formula (Glasgow et al, 2001)
      Slide courtesy Dr Dennis Embry, Paxis Institute (2006)
    • 23. Achieving population-level impact
      Population-level impact =
      Reach x Efficacy
      x Adoption x Implementation x Maintenance
      Slide courtesy Dr Dennis Embry, Paxis Institute (2006)
    • 24. Public health approach to improving parenting requires…
      Maximizing program reach
      Variety of delivery formats
      Efficient delivery
      Provide minimally sufficient supports, but not excessive dosage
      Improving program efficacy
      Meet the needs of diverse families
      Meet diverse levels of families’ needs
      Empower parents to take charge of the supports of they receive
    • 25. Formats for reaching parents
      Home visiting
      Face-to-face office visits
      Parenting groups
      • Brief consultation on a specific problem
      Workshops/seminars
      Self-administered workbooks, written materials
      Videos
      Online programs
      TV broadcasts
    • 26. Meeting diverse levels of need
      Intensive
      Home visiting
      Face-to-face office visits
      Parenting groups
      Medium intensity
      Brief consultation on a specific problem
      Workshops/seminars
      Light-touch
      Self-administered workbooks, written materials
      Online programs
      Videos, TV broadcasts
    • 27. How parents would prefer to receive information about effective parenting
      The highest preference ratings were for TV programs, online programs, written materials
      Lowest ratings were for home visits, therapists, and parenting groups – the most common evidence-based approaches
    • 28. The efficacy of alternative formats and delivery mechanisms
      Home visits, office visits, and parenting groups are the most common evidence-based formats
      But self-administered and other no-clinician formats have shown substantial and sustained effects on parenting and child behavior outcomes, even for at-risk families
      One-time workshop on specific topic
      Self-administered workbook
      Structured online program
      TV series on parenting
    • 29. A public health perspective
      In a public health framework, lighter-touch interventions
      are part of a larger system of supports
      may be sufficient level of dosage for some families
      complement more intensive supports
      extend the reach of parenting programs to those who might not otherwise be reached
      are consistent with the principles of minimal sufficiency and self-regulation
      Even modest effects of lighter-touch interventions could translate into substantial benefits when multiplied across many parents reached
    • 30. Principle of minimal sufficiency
      The principle of minimal sufficiency calls on us to provide interventions that are
      sufficient to meet the need
      but not more than is needed
      This makes efficient use of resources
      Parents’ time
      Professionals’ time
      Provider agency resources
      Public or private funding
    • 31. Principle of parent self-regulation
      Parental
      Self regulation
      Reduced need for support
      Minimally
      Sufficient
      Intervention
    • 32. Triple P - Positive Parenting Program: A sophisticated public health approach to helping parents
      Five-level system
      Level 1 – Universal: Media
      Level 2 – Selected: 1-2 targeted sessions
      Level 3 – Primary care: 4 targeted sessions
      Level 4 – Standard: 8-10 session parenting group or face-to-face
      Level 5 – Enhanced: Intensive intervention for highest-risk families
      Developed by Matt Sanders at the Univ of Queensland in Australia
      20 countries, 18 languages, 4 continents
    • 33. Program topics
      Encouraging behavior you like
      Teaching new skills and behaviors
      Managing misbehavior
      Dealing with disobedience
      Handling fighting and aggression
      Planning for and dealing with high-risk situations
      Establishing good bedtime routines
      Shopping successfully with children
      Raising confident and competent children
      Parental self-care
      Parenting Media Project
    • 34. Triple P formats
    • 35. Service delivery settings and providers
    • 36. Triple P variants
      * Under development
    • 37. Self-regulation framework: Collaborating with and empowering parents
    • 38. Triple P evidence base
      The evidence
      142 studies at
      43 research institutions
      Single case experiments
      Meta
      analyses
      Efficacy trials
      Population trials
      Effectiveness trials
      25 further trials in progress
      as of September 2010
    • 39. Effects of population trial of Triple P system on child maltreatment
      Fewer out-of-home placements
      Fewer substantiated child maltreatment cases
      Fewer child maltreatment injuries (hospital and emergency room)
      Effect sizes up to d=1.22
    • 40. Effects of TP workshop on disobedience Morawska, A., Haslam, D., Milne, D., & Sanders, M.R. (in press). Effects of a Brief Parenting Discussion Group for Parents of Young Noncompliant Children. Journal of Developmental & BehavioralPediatrics.
      Lower level of conduct problems
      Less dysfunctional parenting
      Less anger
      Less conflict over parenting
      High consumer satisfaction
      Effect sizes up to d=1.6
      Child behavior problems - intensity
    • 41. Effects of Triple P Online
      Child behavior problems - intensity
      Lower levels of child conduct problems
      Less dysfunctional parenting
      Greater parenting confidence
      Less parental anger
      High consumer satisfaction
      Effect sizes up to d=1.49
    • 42. Effects of Triple P Media Series
      Lower levels of child conduct problems
      More child prosocial behaviors
      Less dysfunctional parenting
      Greater parenting knowledge
      Effect sizes up to d=.75
      Parenting Media Project
    • 43. The importance of appeal and engagement to achieving outcomes
      If we can’t engage parents, they won’t benefit
      Acknowledging parents as consumers with preferences
      Formats that fit ecologically into their lives
      Messages that engage and resonate
      Strategies that address their needs
    • 44. Improving reach, appeal, and effectiveness for diverse populations
      Still much to learn about how to maximize the reach, appeal, and effectiveness of family interventions for different…
      Income groups
      Racial/ethnic groups
      Degrees of family risk and difficulties
      Improving the reach, appeal and effectiveness of interventions to diverse populations increases overall public health impact, and helps us meet the needs of individual families before us.
    • 45. Broad reach, broad appeal
      Goal of the Triple P Parenting Media Series was to create a “media product” that has broad reach and broad appeal
      Engaging, entertaining, watchable
      Realistic
      Appealing to a diverse audience
      Mothers and fathers
      Income levels
      Ethnic and racial groups
      Different levels of challenge with children
      So that everybody can see themselves in it
      Parenting Media Project
    • 46. Preliminary results – appeal
      High rates of watching the Triple P Parenting Media Series
      High satisfaction ratings: interesting, entertaining, useful, familiar situations, relevant to daily life
      Broad appeal across racial/ethnic, income, and educational groups, and other family characteristics
      Non-working moms and those most challenged by children’s behavior problems are finding it most useful
      Those with lower education and lower self-efficacy have been more likely to watch all episodes on schedule
      Parenting Media Project
    • 47. In conclusion…
      A public health approach focuses on
      population-level impact
      reaching as many families as possible
      variety of formats
      varying levels of intensity
      minimally sufficient dosage
      empowering parents to take charge of the help they receive
      With a public health approach, we can
      reach a large number and broad range of parents
      engage them in the message
      encourage them to try out new skills
      have a substantial impact on important outcomes
      Parenting Media Project
    • 48. Implications and challenges
      For researchers and program developers:
      to develop and test programs in a variety of formats and different levels of intensity, with broad reach, broad appeal, AND good efficacy
      For practitioners:
      To incorporate a public health perspective into practice
      adapting to diverse needs
      utilizing a variety of formats, delivery mechanisms, and levels of intensity to meet family needs
      Parenting Media Project
    • 49. Thank youTriple P information at www.triplep.net
      Parenting Media Project

    ×