Triple P Presentation for First 5 Santa Cruz County Commission
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Presentation on the status of implementing the Positive Parenting Program (Triple P) in Santa Cruz County. Triple P is an evidence-based, public health approach to parent education and support. Implementation in Santa Cruz County is a multi-year project involving public agencies, nonprofits and independent practitioners.
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Triple P Presentation for First 5 Santa Cruz County Commission
- 1. The Positive Parenting Program (Triple P) First 5 Santa Cruz County Commission Meeting September 22, 2010
- 2. Desired Outcomes Understand the Triple P system and how it is being implemented in Santa Cruz County. Learn about agencies’ early experiences with implementing Triple P. Review initial outcome data. Understand the steps being taken to build service capacity and leverage funding.
- 3. What is Triple P? An evidence-based, public health approach to parenting and family support Increase parents’ confidence and competence in raising their children Improve parent-child relationships De-stigmatize parent education and support Increase access to parenting information and services
- 4. 5 Principles of Positive Parenting Ensuring a safe, engaging environment Creating a positive learning environment Using assertive discipline Having realistic expectations Taking care of yourself as a parent
- 6. Triple P Levels of Intervention Level 1 – Universal - Media-based parenting information campaign Level 2 – Selected Individual & Seminar - Information or advice for a specific parenting concern Level 3 – Primary Care - Narrow-focus parenting skills training Level 4 – Standard & Group - Broad-focus parenting skills training Level 5 – Enhanced & Pathways - Additional interventions for families with risk factors
- 8. Self-Regulatory Framework Practitioner provides information, skills training and support based on what the parent needs or wants…. …which may be different than what the practitioner needs or wants. Parent uses self-evaluation to set goals and assess progress Parallel process: Practitioner helps Parent build confidence & competence Parent helps Child build confidence & competence
- 9. 17 Core Parenting Skills Promoting positive relationships Brief quality time, Talking to children, Affection Encouraging desirable behavior Praise, Positive attention, Engaging activities Teaching new skills and behaviors Modeling, Incidental teaching, Ask-say-do, Behavior charts Managing misbehavior Ground rules, Directed discussion, Planned ignoring, Clear & calm instructions, Logical consequences, Quiet time, Time-out
- 10. 17 Core Parenting Skills
- 11. Santa Cruz County Triple P Pilot Sponsors: First 5 Santa Cruz County, HSA - Children’s Mental Health, HSD – Family & Children’s Services Long-term vision = implement all levels Start small with interested agencies and staff Implement levels incrementally, starting with Levels 4 & 5 Conduct pilot for a minimum of 2 years
- 12. Pilot Plan – Year 1 (FY 2009-10)
- 13. Pilot Plan – Year 2 (FY 2010-11) Trainings Level 4 Standard/Group (1 training, 20 practitioners) October 2010 Level 3 Primary Care (1 training, 20 practitioners) October 2010 Level 2 Seminars (1 training, 20 practitioners that have been accredited in Level 3 or 4) January 2011 Level 1 Universal Agencies – TBD
- 14. Practitioners’ Experiences Name & Organization/Affiliation Level(s) accredited in How Triple P is being implemented by you and/or your organization How parents are responding to Triple P services Successes, challenges and next steps
- 15. Evaluation Measuring outcomes at individual/family and community levels Extensive set of assessments for Levels 4/5 Briefer set of assessments for Levels 2/3 Preliminary data January – June 2010: ~100 parents served (Levels 3-5) Informed consent from ~50 parents Level 4 outcome data for ~30 parents On average, high levels of client satisfaction
- 16. Parent’s Perception of Child Behavior (Intensity)
- 17. Parent’s Perception of Child Behavior – (# of Problems)
- 18. Parent’s Perception of Child Behavior - % in Clinical Range
- 19. Parenting Style
- 20. Parenting Style – % in Clinical Range
- 21. Parenting Confidence n = 34
- 22. Parenting Confidence – % in Clinical Range
- 23. Client Satisfaction – Overall
- 24. Building a Sustainable Model for Funding & Service Expansion
- 25. Leveraging Funding Triple P America Fee-for-Service Coordination Contracts with Agencies
Editor's Notes
- Individual change: Parenting style/skills, child behavior (as per parent)Family change: Parent-child relationship; Couple/co-parent relationshipCommunity change: Shift in community attitudes/norms about parenting and help-seekingSystem change: Improved coordination of funding, service provision (referrals)
- Minimal sufficiency = give “just enough” support to a parent to promote self-sufficiency and problem-solving without creating dependency.Not every parent needs face-to-face, intensive, long-term services, BUT when parents want or need more, they can get itDosage/exposure is greatest at lowest levels (1-3)Intensity of services is greatest at highest levels (4-5)
- Parent sets goals Parent “owns” the interventionPractitioner continually prompts parent to do self-evaluation and self-improvement what did you do well/what worked well? what could you do differently?- Parent uses same technique to help promote child’s self-regulation
- Major premise of Triple P is that many parents seek help when they’re struggling with how to handle their children’s behaviorDoesn’t mean that program labels children as bad or that entire focus is on changing children’s behavior vs promoting positive parent-child relationshipIt does meant that Triple P “starts where the parents are at” by helping them develop their skills and confidence to manage their children’s behaviors that are challenging for them In the process, parents learn that when they modify their own behaviors and responses, their children’s behaviors change and the quality of the parent-child relationship improves Eyberg Child Behavior Inventory: measures parent’s perception of child’s behavior, both frequency of behaviors and whether those behaviors are problems for the parentThis chart shows average pre/post scores about how often challenging behaviors occur (Intensity) on a scale of 1 (never) to 7 (always)If scores are above the dotted line (131), responses are in the “clinical range” – indicates area of concern, risk factor29 matched sets of pre/post data
- The Eyberg also measures parents’ perception of whether each behavior is a problem (Number of problems). Scores above the dotted line are in clinical range of concern (parent reported that 15 or more behaviors were problems)30 matched sets of pre/post dataAverage pre/post scores show some parents in the clinical range at pre, large decrease at postWhen look at average pre/post scores, can see that pre/post scores changed in the desired direction (decreased), but looks like very few, if any, parents scored in the clinical range at either pre or post
- However, when we look at the % of parents whose scores were in the clinical range at pre/post, we can see that 40% of parents had scores in the clinical range in the pre-assessments(high intensity of challenging behaviors), and that dropped to 10% at post.
- Parenting Scale asks how parents respond to various situations/behaviors with their childrenSpecifically measures parent’s level of Laxness, Over-Reactivity, Hostility risk factors for child maltreatmentIf scores higher than dotted line, in clinical range of concern (different cut-offs for males/females)32 or 33 matched sets of pre/post data, depending on subscale (parent didn’t answer certain questions)When look at average pre/post ratings, see changes in desired direction (want to see decrease in scores; n’s too small to calculate statistical significance)But, it looks like no parents scored in the clinical range of concern (not many concerns/risk factors)
- However, this chart shows the % of parents in the clinical range (area of concern) pre and post Triple P. When look at data in this way, can see that a significant % of parents were in clinical range when they complete pre-assessments, and large decreases in % in clinical range at post
- Parenting Tasks Checklist measures parents’ level of confidence in successfully handling different behaviors in various settings.Rating scale = 0 (Certain I can’t do it) – 100 (Certain I can do it)34 matched sets of pre/post dataAverage pre/post scores changing in desired direction (increased), but doesn’t look like any parents were in clinical range of concern
- Again, when we look at the % of parents in the clinical range before and after Triple P, the extent of the improvements is much more clear.
- On average, high levels of satisfaction.This chart shows average ratings from all agencies for all levels (Jan – June)
- Building sustainable model of funding services that is consistent with public health model i.e. want to make services accessible to all segments of community, not just highest need families that are already in “the system”Acknowledge that some parents will be able/willing to pay for servicesSome agencies already receiving funding to provide parent education and/or brief services can be integrated into existing programsSome services may be covered by health insurance (Medi-Cal, private insurance)
- F5 allocated funds for Triple PHSA – Children’s Mental Health: contracted with First 5 to implement portions of PEI strategies, including Triple PHSD – FCS: able to claim Title IV-E training funds, reduced actual cost of training, First 5 provides match saved training funds redirected to servicesFirst 5: streamlined process for contracting with Triple P America (trainings), purchasing resources/materials, contracting with coordinator, purchasing services from organizations/practitioners