triple p az: proof of positive parenting...triple p az ‐23rd cap conference 7/25/17 1 triple p az:...

Triple P AZ ‐ 23rd CAP Conference 7/25/17 1

Triple P AZ: Proof of Positive Parenting

23rd Arizona Child Abuse Prevention ConferenceJuly 25, 2017

Cricket Mitchell, PhDTriple P AZ Coordinator, Prevent Child Abuse ArizonaRandy Ahn, PhD, MLISImplementation Consultant, Triple P America

Triple P – Positive Parenting Program2

Triple P is an evidence-based multi-tiered system for improving parenting practices, family well-being, and children’s social and emotional well-being.

Breadth of Reach

Inten

sity

Level 5

Level 4

Level 3

Level 2

Level 1

Intensive Family Intervention

Broad Focus Parenting Skills Training

Narrow Focus Parenting Skills Training

Brief Parenting Education

Communications Strategy

Decreases parental stress

Decreases parental anxiety

Decreases parental depression

Decreases child behavior problems

Improves parenting competencies

Improves family communication skills

Improves family relationships

What does Triple P DO for Families?3


Decreases rates of child maltreatment

Decreases out-of-home placements

Decreases child injuries due to child abuse or neglect

What does Triple P DO for Communities?4

Triple P AZ – Calendar Years 2015-2016*

Triple P data contributed by: Cradle 2 Crayons Casa de los Niños

Devereux Jewish Family & Children’s Services Lutheran Social Services of the

Southwest

Maricopa County Department of Public Health

Phoenix Children’s Hospital West Valley Child Crisis Center West Yavapai Guidance Clinic

5

*Triple P service provision began in Fall 2015. Individual family-level data, including pre/post outcomes using standardized questionnaires, were collected only for the Level 4 interventions. Funding for statewide coordination and evaluation, as well as training in Level 4 Standard and Level 4 Group interventions, was generously provided through a Steele Foundation Triple P Capacity-Building Grant to Prevent Child Abuse Arizona.

English

84%

Spanish

16%

Language of Triple P Service: 105 58

20

175 539

4

10

0% 20% 40% 60% 80% 100%

Level 2 Seminars Level 3 Discussion Groups

Level 3 Primary Care Level 4 Standard

Level 4 Group Level 4 Standard Stepping Stones

Level 4 Group Stepping Stones

Triple P AZ Service Delivery6

911 Arizona parents participated in Triple P Positive Parenting education, support, and intervention services in 2015 and 2016.*

91% of the 728 parents who participated in Level 4 Triple P services reside in Maricopa County.

*Service provision began in Fall 2015.


Female, 280 Male, 415

0% 20% 40% 60% 80% 100%

54

4

226 275 98

12

0% 20% 40% 60% 80% 100%

African American Asian/Pacific Islander Caucasian

Hispanic/Latino Multiracial Native American

Level 4 Triple P Child Characteris cs:

Triple P AZ Service Recipients7

Level 4 Triple P Parent Par cipant Characteris cs:

Female, 590 Male, 110

0% 20% 40% 60% 80% 100%

55

7

309 270 34

0% 20% 40% 60% 80% 100%

African American Asian/Pacific Islander Caucasian

Hispanic/Latino Multiracial Native American

Triple P AZ Clinical Measures

Common set of core clinical measures used pre/post Triple P AZ Level 4 services

Child Behavior

Parenting Style

Family Rel

Parent Adj

Eyberg Child Behavior Inventory

ECBI

Parenting and Family Adjustment Scales

PAFAS

Depression, Anxiety, and Stress Scales

DASS-21

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Outcome Domain: Child Behavior

Parents who completed the ECBI pre- and post- Level 4 Triple P showed: an improvement of 19%

in the intensity of their children’s disruptive behaviors; and,

an improvement of 35% in the extent to which their children’s behaviors are problematic.

Improvements observed in child behavior are statistically unlikely to be due to chance

9


20

1417

11

0

5

10

15

20

25

30

35

Parenting Practices Scale(n=393)

Family Adjustment Scale(n=394)

Ave

rag

e S

cale

Sco

re

Parenting and Family Adjustment Scales (PAFAS)Pre/Post Parenting Practices and Family Adjustment Scale ScoresTriple P AZ Level 4 Interventions

2015 and 2016

Pre

Post

Outcome Domains: Parenting Style and Family Relationships

Parents who completed the PAFAS pre- and post- Level 4 Triple P showed: an improvement of 14% in

their parenting practices (i.e., lower levels of coercive parenting, higher levels of consistency and positive encouragement, and improved parent-child relationships); and,

an improvement of 19% in family adjustment (i.e., parental adjustment, family relationships, and parental teamwork).

Improvements observed in parenting practices and family adjustment are statistically unlikely to be due to chance

10

Outcome Domain: Parental Adjustment

Parents who completed the DASS-21 pre- and post- Level 4 Triple P showed: an improvement of 38% in

their reports of depression symptoms;

an improvement of 36% in their reports of anxiety symptoms; and,

an improvement of 31% in their reports of stress symptoms.

Improvements observed in parental adjustment are statistically unlikely to be due to chance

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Clinically Significant Improvements

69%

Parental Depression

54%

Intensity of Child Behavior Problems

49%

Extent to which Child Behaviors are Problematic

78%

Parental Anxiety

90%

Parental Stress

Each circle represents all parents who began Level 4 Triple P in the clinical range for child behavior problems and/or parental adjustment. The green portion represents the percentage who then completed Triple P in the non-clinical range.

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We’re Off to a Great Start!13

After two years of dedicated funding (from private, state, and federal agencies) to support Triple P training and service delivery in Arizona Hundreds of parents are receiving evidence-based positive

parenting education, supports, and interventions that meet their individual and unique family needs

Families participating in Level 4 Triple P (short-term, focused parenting skills interventions) are demonstrating improvements in child behavior, parenting style, family functioning, and parental adjustment that are both statistically significant and clinically meaningful

The majority of Triple P AZ service providers are committed to ongoing voluntary data collection to continue to contribute to the statewide story of success for local families Thank you to the Steele Foundation for continuing to support

Prevent Child Abuse Arizona in Triple P Capacity-Building

Let’s Keep the Momentum Going!

Partnerships provide opportunities for shared resources and cost savings Public agencies, provider

organizations, non-profits, universities, funders…

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Multi-sector, multi-agency commitment to expanding the availability of Triple P prevention and intervention services across the state, as well as maintaining the current level of Triple P service delivery, will allow us to start to see the community-level impact we would expect from high-quality Triple P

A Global Perspective

Consider the relationship between wealth of nations, families, and quality of life

Hans Rosling 1948‐2017

About ten years ago Hans Rosling, Professor of International Health, Karolinska Institute gave a Ted talk that challenged our understanding and preconceptions of the world, of poverty, and of families.


A Global Perspective

Consider the relationship between wealth of nations, families, and quality of life

Hans Rosling 1948‐2017

Social change comes before economic change.

Jurisdictions use their money better now than they have in the past.

You can move much faster if you are healthy first instead of wealthy first.

Population health is the foundation upon which social and economic well‐being rests

Population Health

Population Health is defined as the health outcomes of a group of

individuals, including the distribution of such outcomes within the group.Kindig

Health: A state of complete physical, mental, and social well‐being and not

merely the absence of disease or infirmity.World Health Organization

Pop Health

Mental Health

ACEs ECE Schools

Public Health Health Services

Strengthening FamiliesChild Welfare

Improvingpopulationhealth.orgKindig, 2014

Population Health


County Health Rankings Modelhttp://www.countyhealthrankings.org/

Arizona Health Outcomes ‐ 2017

Health Factors

Health Behaviors 30%

Clinical Care 20%

Social/Economic 40%

Physical Environment 10%

Health in All Policies

Rudolph, L., Caplan, J., Ben‐Moshe, K., & Dillon, L. (2013). Health in All Policies: A Guide for State and Local Governments. Washington, DC and Oakland, CA: American Public Health Association and Public Health Institute.


County Health Rankings Model

Children

P

a

r

e

n

t

s

http://www.countyhealthrankings.org/

A couple of indicators

Single Parent Families Rates

US 34%

Access to Exercise Rates

US 84%

AZ 36% AZ 86%

2014 US Census BureauAmerican Community Survey 2011‐2015

County Single Parents %

Apache 52

La Paz 50

Gila 47

Navajo 45

Mohave 41

Pima 39

Coconino 38

Santa Cruz 36

Maricopa 36

Greenlee 36

Pinal 35

Cochise 34

Graham 34

Yavapai 33

Yuma 31

County Access to Exercise%

Apache 22

La Paz 33

Santa Cruz 39

Graham 43

Greenlee 43

Navajo 47

Mohave 65

Pinal 70

Cochise 73

Yuma 77

Coconino 82

Gila 82

Pima 86

Yavapai 90

Maricopa 93

What is Triple P?An evidence‐based population approach for improving parenting practices and children’s social and emotional well‐being.

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Intensive family intervention

Broad parent training

Narrow parent training

Brief consults/Seminars

Media strategy

InterventionIntensity

Population Reach

Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information.

Improves parent anger management, coping with stress, co‐parenting; reduces child obesity, behavior problems

Improves parent‐child relationships, encourages and teaches positive behaviors, manages misbehavior

Improves ways of handling common behavior problems and developmental challenges

Brief consults for discrete problems, seminars for raising resilient kids and conveying positive parenting strategies

Outreach and media strategy for de‐stigmatizing parent education and facilitating referrals

4‐14

8‐10

1‐4

1‐3

0

Encounters



25





Media strategy

InterventionIntensity

Population Reach

Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information.

Improves parent anger management, coping with stress, co‐parenting; reduces child obesity, behavior problems

Improves parent‐child relationships, encourages and teaches positive behaviors, manages misbehavior

Improves ways of handling common behavior problems and developmental challenges

Brief consults for discrete problems, seminars for raising resilient kids and conveying positive parenting strategies

Outreach and media strategy for de‐stigmatizing parent education and facilitating referrals

4‐14

8‐10

1‐4

1‐3

0

Encounters

Triple P Strategies

Manage Challenging Behaviors

Teach New Skills & Behaviors

Encourage Positive Behaviors

Develop Positive Relationships

Re‐organization of parenting time and effort from overly harsh or lax practices to ones that build attachment and positive parent‐child relationships.

Re‐setting the set point for family hostility and conflict

Re‐orientingparents to thepower oflove

Brief quality time, talking tochildren,affection

Praise, positive attention,engaging activities

Modelling, incidental teaching, ask‐say‐do, behavior charts

Ground rules, directed discussion,planned ignoring, clear, calm instructions, logical consequences, quiet time, time‐out

TEMPERAMENT X ATTACHMENT STYLE X POSITIVE PARENTING = CHILD SELF‐REGULATION

What is Triple P?An evidence‐based population approach for improving parenting practicesand children’s social and emotional well‐being.

Principles of Positive Parenting

Safe & engaging environment

Positive learning environment

Assertive discipline

Realistic expectations

Taking care of yourself

Practitioners Parents

ObserveAnalyzePracticePlan aheadSelf reflectAdjust

ModelInstructRole playDiscussCollaborateFacilitate

PositiveParenting Strategies

Cognitive‐behavioral content

Insight‐oriented process

SelfRegulation


Population Health and Parenting

Pop Health

Mental Health

ACEs ECE Schools

Public Health Health Services

Strengthening FamiliesChild Welfare

Population health approaches incorporate both the formal or governmental health system and the informal system.

Triple P works with all systems of care that are focused on improving child social and emotional well‐being.

CDC Triple P US Population Trial

Key Findings

22% fewer out of home

placements per year(240 fewer/100,000)2

16% fewer hospitalizations/ER

visits for child maltreatment injuries/year (60 fewer/100,000)2

17% fewer substantiated child

abuse cases/year (688 fewer/100,000)2

1. Prinz, R. J., Sanders, M. : R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population‐‐based prevention of child maltreatment: The U.S. Triple P System Population Trial. Prevention Science,10(1), 1‐12.

2. Standardized prevention rates per 100,000 children ages 0‐8 yrs. 29

CA Child Abuse Rates and Triple P(dedicated to Hans Rosling)

Size of bubble = County PopulationX axis = Substantiated Child Abuse RateY axis = Triple P Practitioners




6 county view



6 county view



6 county view




6 county view

Child Well‐being

Parenting

Parent Adjustment

Systems

Communities

Behavior, parent‐child attachment, self‐control, confidence, & autonomyAdverse childhood experiences

Positive parenting , parent‐child attachment, confidence, and self‐sufficiency, organizational skillsCoercive parenting

Relationship satisfactionStress, anxiety, and depression, parental conflict

Collaboration across sectors, a common language for parenting supportSilos

Health and wellbeing of populationBurden of disease and child maltreatment

Improved quality and experience of care

Decreasedcosts of care

Improved health and wellbeing of population


ExpectedOutcomes

County Health Rankings Action Centerhttp://www.countyhealthrankings.org/roadmaps/action‐center

Community and Strategic PlanningStep by step guidance

Partner GuidesEngaging cross sector partners

• Take Action!• Positive Parenting can mediate

Population Health• Every sector wants to contribute to the

solution and they can.






Media strategy

Human Service Providers

Mental Health

Behavioral Health

Primary CareSubstance Abuse

Domestic Violence

Shelters

Schools

Libraries

Early Childhood Ed

Faith‐based

Tribes

Public Health Child Welfare

Courts

Child care

Community clinics

Special Ed

Developmental Disabilities

Military

Promotores

Corrections

Probation

Triple P Interventions

Brief Primary CareSeminars

Primary CareDiscussion Groups

StandardGroup

EnhancedPathwaysFamily TransitionsGroup LifestyleStepping Stones

(Special needs)

Teen Variants

Families

Triple P Online

Foster care

Juvenile Hall

Adoption

Family Courts

County Health Rankings Action Centerhttp://www.countyhealthrankings.org/roadmaps/action‐center

http://digitalmaterials.triplep.net/start.html

Take Action!

Advocate for evidence-based parenting!

Normalize help-seeking for parents – every parent needs (at least) a little bit of help!

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Cricket Mitchell, PhD

Triple P AZ Coordinator, Prevent Child Abuse Arizona

[email protected]

858-220-6355

Randy Ahn, PhD, MLIS

Implementation Consultant, Triple P America

[email protected]

310-694-7566

Questions and Discussion49

triple p az: proof of positive parenting...triple p az ‐23rd cap conference 7/25/17 1 triple p az:...

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