1. Implementation and Cost Benefits of the Triple P System Ron Prinz, Ph.D. Carolina Distinguished Professor Director, Parenting and Family Research Center University of South Carolina The Triple P Positive Parenting Symposium A Promising Strategy to Reduce Child Maltreatment December 8, 2009

2. Parenting and family support that is: Cost Effective AND Population Wide Is this a contradiction of goals?

3. Population-wide dissemination requires: Multi-level parenting intervention Evidence-based programming Efficient parenting intervention designed specifically for population-based dissemination.

4. Triple P System of Parenting Interventions

5. Universal strategy Does not have to mean every family gets intensive intervention or even non-intensive face-to-face programming Triple P emphasizes universal access to evidence-based parenting information, not 100% direct service delivery

6. Combine strategies for efficiency Blending of: -- Universal prevention -- Selected prevention -- Indicated prevention -- Early intervention -- Treatment

7. Achieve multiple goals with same parenting intervention Prevention of children’s social, emotional and behavioral problems Prevention of child maltreatment (abusive parenting) Promotion of healthy child development, readiness for school Family-based treatment of child mental-health problems

8. Ways to get more out of a population approach

9. Media strategies Why should individual practitioners care about Triple P media strategies? Parental receptivity –Normalize seeking of parenting/family support –De-stigmatize participation –Stimulate interest and action Validate positive parenting Reinforce practitioners Extend practitioners’ work

10. Media Coverage

11. Media strategies Multiple publicity strategies –Press releases linked to local interests –Reporter-initiated news stories –Positive parenting articles –Radio public-service announcements (PSAs) –Community events –School newsletters, other mailings –Bumper stickers, memorabilia Involve larger numbers of parents in lower program levels (e.g., parenting seminars)

12. Role of practitioner is critical Triple P is a framework and comprehensive set of tools Triple P is NOT a cookbook “Manual with a brain” Don’t leave your communication and analytical skills at the door Beyond training: –Self-regulation of professional development –Peer support networks (to learn from peers)

13. “It Doesn’t Work with My Families” The “It” (Triple P) is a framework with many different “ITS” Same thing is sometimes heard in schools: –“Some children cannot learn” –“I cannot get through to this child” When faced with challenging situations: –Focus heavily on process –Utilize supervisory and peer support resources –Simplify the initial goals –Make sure that a mandate from the parent has been achieved

14. Peer support networks Within and across agencies Diversity of client populations is good Collective problem-solving Expanding your repertoire

15. Parents as consumers Let parents in the community know about Triple P (even if your organization doesn’t work directly with your network of parents) Involve parents and parent advocates in community planning committees Document parental opinions about Triple P

16. Triple P as value added Triple P is not meant to supplant other kinds of services Child trauma treatment Substance abuse treatment of parents Housing, health care, and sustenance needs

17. Population dissemination Can be several systems at once Or, incremental Complete population dissemination: –An ideal to strive for –Not an end state –Find the levels of penetration sufficient to produce positive changes in prevalence of target problems

18. Cost and benefit considerations

19. Summary cost Population that includes100,000 families Cost of Triple P system dissemination infrastructure: –Per child birth to 12 years $11.74 cost per child

20. Cost basis Population of approximately 500,000 people Costs included: –All levels of Triple P training –All practitioner materials –Pre-training consultation –Post-training consultation and support –Implementation of media strategies Costs not included: –Parent resource materials –Workforce itself

21. Potential benefits and cost offsets

22. Estimating impact on child abuse www.paxis.org/triplep Estimator for U.S. states Not yet calibrated for Canada, but gives general sense of cost offsets

23. Triple P Prevention Estimator Apply population-trial effects to other geographic areas Example: Florida FL Pop: 1,977,541 children birth to age 9 FL Child Maltreatment: 89,072 cases in 2006 FL Out of Home Placements: 10,421 placements in 2006

25. Triple P Prevention Estimator Select tab “Out of Home Placements” Set the $ value for annual cost of one out-of- home placement (let’s choose $18,000) If population preventive effects occurred in Florida, this would result in: –Reduction of 2,657 placements in a year –Savings of $47,832,390 in a year ($18,000 times 2,657)

27. Triple P Prevention Estimator If the effects in Florida were half as strong as those found in the population trial, then: –Out-of-home placement savings would be $23,916,195 in a year Express the anticipated savings as a range: –Between $23 and $47 million annually for out-of- home placements

28. Not Included in Savings Estimate Long-term cost offset in terms of sequalae of child maltreatment Reduction of children’s social, emotional, behavioral, and health problems (general population) –Short-term reduction of services costs –Long-term cost offsets

29. Sources of efficiency Utilize existing workforce across many settings, agencies, and providers Combine goals that have in common parenting intervention De-stigmatize participation by parents Parenting interventions designed for population dissemination Build on evidence-based system of interventions Use the tiered model that draws on media and low-intensity interventions as the base

30. Conclusions 1.Dissemination of the Triple P system has produced clear impact on prevalence of child maltreatment at a population level 2.First time ever that a population randomization trial on child maltreatment has been conducted and yielded preventive effects 3.Cost effectiveness of the Triple P population approach grounded in several sources of efficiency

31. Key References Results of U.S. Triple P System Population Trial: Prinz RJ, et al. (2009) Population-based prevention of child maltreatment: The U.S. Triple P System Population Trial. Prevention Science, 10, 1-12. Cost considerations: Foster EM, et al. (2008). The costs of a public health infrastructure for delivering parenting and family support. Children and Youth Services Review, 30, 493-501. Mihalopoulos C, et al. (2007) Does the Triple P—Positive Parenting Program provide value for money? Australian and New Zealand Journal of Psychiatry, 41, 239-246. Overview of Triple P and evidence base: Sanders MR (2008) Triple P—Positive Parenting Program as a public health approach to strengthening parenting. Journal of Family Psychology, 22, 506-517. Nowak C & Heinrichs N (2008) A comprehensive meta-analysis of Triple P—Positive Parenting Program using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114-144. ESTIMATOR for cost savings (child maltreatment prevention) http://www.paxis.org/triplep