1. CDC-Funded Triple P System Population Trial
Presented by:
Ron Prinz, University of South Carolina

2. U.S. Triple P System Population Trial
Principal Investigators: Ron Prinz & Matt Sanders
Funding Agency: Centers for Disease Control and Prevention (CDC)
Project Director: Cheri Shapiro
CDC Collaborating Officials: Dan Whitaker, Kendell Cephas

3. Key points for this presentation
Description of the population trial—which is midway towards completion
Illustration of the range of service providers and agencies involved in Triple P delivery
Reflections on feasibility, acceptability, benefits for workforce
Indications of population penetration thus far

4. Primary aims of the trial
Reduce risk for child maltreatment
Reduce risk for child behavioral/emotional problems
Implement all levels of the Triple P system to promote positive parenting principles and strategies population-wide
Test population penetration of the system
Assess impact at population level, rather than with individuals at a clinical level

5. Background context of trial
South Carolina context backdrop for the trial:
Significant funding cuts to social services and family mental health services
Multiple disciplines and agencies serving target population with little cross-coordination
Services often disconnected, relying on conflicting approaches, having poor referral pathways
Service providers usually experienced but often inadequately trained
Little prior exposure to evidence-based parenting programs

6. Research design 18 counties located in South Carolina:
Each between 50,000 and 175,000
None with prior exposure to Triple P
Random assignment of counties:
Triple P System
Comparison (services as usual)
Counties were matched on child abuse rates, poverty, and population size

7. South Carolina counties
Intervention Counties
Comparison Counties

8. Target population All families:
with children in the birth to 7-year-old range
residing in the nine Triple P counties (or the nine comparison counties)

9. Child maltreatment; Childhood Injuries
Child maltreatment (birth to 7 years)
17.5 investigated cases per 1,000 children
6.5 founded (substantiated) cases per 1,000 children
Child out-of home placements: 3.8 placements per 1,000 children
Child injuries (hospitalization and ER visits): 615 visits per 10,000 children
However, official records grossly underestimate the extent of detrimental parenting practices

10. Coercive parenting practices

11. Coercive parenting practices

12. Strategies to de-compartmentalize
Avoid narrow linkage to child abuse
With practitioners
With parents
Promote adoption of key Triple P assumptions
Disseminate all levels of Triple P

13. Avoid narrow linkage to child abuse
With practitioners:
NO: “Triple P is being disseminated to prevent child abuse.”
YES: “Triple P benefits parents and children in many different circumstances.”
With parents:
NO: “We are providing this parenting and family support so that you don’t abuse your child in the future.”
YES: “Good parenting and family support is for every parent.”

14. Promote key assumptions of Triple P
Principle of sufficiency
Parenthood preparation is about promoting flexibility, adaptation and capacity to change
Promote parental self-regulation, family-driven goal setting, flexible delivery modalities and program intensities

15. Key assumptions continued
Multidisciplinary:
Practitioners from many disciplines who serve families
No discipline “owns” or controls Triple P
As a result:
Involve many settings and service providers
Create multiple access points for families

16. Levels of intervention
Universal Triple P
Level One
Selected Triple P
Level Two
Primary Care Triple P
Level three
Standard Triple P
Level four
Enhanced Triple P
Level five

17. Universal Triple P Triple P Media strategy Normalize Empower Validate
De-stigmatize
Validate

18. Strategies to increase public awareness
Multiple publicity strategies
Press releases
Reporter-initiated news stories
Positive Parenting articles (Sanders)
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)

19. Constructive media coverage

20. Level 2: Triple P Seminar Series
The Power of
Positive
Parenting
Seminar 2
Raising
confident,
competent
children
Seminar 3
Raising
resilient
children
90 minute large group
parenting seminars
Invitation to return

21. Communications strategy: Cumulative view

22. Training of service providers

23. Providers of Triple P: Settings
Mental health centers
Health clinics
County child welfare departments
Elementary schools
Preschools and daycare centers
NGOs and non-profit organizations
Churches and other religious institutions
Private sector

24. Triple P providers: Mental health system
Therapists
Counselors
Home-visiting staff
Case managers, supervisors
Disciplines: social work, psychology, marriage and family therapy, counseling, nursing, parent educator, psychiatry

25. Triple P providers: Child welfare system
TANFF workers
Outreach and home-visiting staff
Case managers, supervisors

26. Profile of providers

27. Profile of Triple P providers
Number of providers trained (through 2005)
568
Mean age of providers
43.5 yrs
% in present position greater than 5 years
42%
Ethnic backgrounds
European Americans
African Americans
Other racial/ethnic
54%
40% 6%
Mean # of years in parent consultation work
Greater than 5 years
Greater than 10 years
81%
59%

28. Training impact on providers’ parent consultation skills

29. How satisfied were providers
How satisfied were providers? 1=very dissatisfied; 7=extremely satisfied
Overall Satisfaction with Training
Mean (SD)
Part 1 of Training
6.24 (1.12)
Part 2 of Training (when providers asked to demonstrate competencies)
6.47 (1.14)

30. Growth in Triple P providers

31. Population assessment
Not feasible to assess individual families
Need to rely on available population indicators
Archival data, even with inherent limitations, can be useful
Telephone surveys of random households provide population snapshots
Practitioners can provide useful data
Cost effectiveness analysis

32. Archival data Child maltreatment
Rates of investigated CM
Rates of founded (substantiated) CM
Child injuries (hospitalizations and ER visits)
Child out-of-home placements

33. Tracking key constructs
Child maltreatment
Rates of investigated CM
Rates of founded (substantiated) CM
Child injuries (hospitalizations and ER visits)
Child out-of-home placements
Growth in number of Triple P providers
Awareness of Triple P in the population
Population reach: Parent exposure to Triple P interventions

34. Child out-of-home placements
Baseline Years

35. Telephone surveys of households
Random telephone survey of households (families with at least on child 6 mos. to 7 yrs. old)
1,800 households in intervention counties
Gauge awareness of Triple P
Other variables:
Parenting practices
Child behavioral/emotional problems
Parental accessing of services

36. Parental awareness of Triple P

37. Population reach of Triple P to date
Eligible population: 85,000 families with a child birth to 7 years old
To date: 12,197 families have received direct services via Triple P programming
% receiving Triple P interventions per year (excluding media exposure)

38. Some lessons learned thus far
Front-line staff working in different agencies and settings want collaboration and cross-agency communications
Triple P offered common terms, intervention methods, and system without requiring complex interagency agreements
Building up a positive contagion effect takes:
Patience
Multiple strategies
Sustaining of community engagement

39. Conclusions thus far Population trial has demonstrated:
Feasibility of disseminating the entire Triple P system at one time
Substantial uptake despite community infrastructure problems, fractured delivery systems
Growing awareness of Triple P among parents throughout the population
Potential detectability of population impact through archival data systems

40. Conclusions Biggest line item of service delivery is personnel:
Dissemination of the Triple P system is not requiring the addition of service delivery personnel
Using the existing workforce
Training, parenting resource materials, consultation and support
The U.S. Triple P System Population Trial is providing a unique opportunity to examine long-term, cumulative impact on the population and on service providers.

42. Thank you for your attention

44. Longitudinal tracking of providers
To assess numbers of families receiving Triple P
Telephone interview 6 months after Triple P training
526 providers interviewed to date
Participation rate: 94.3%
Telephone interview 18 months after Triple P training
325 providers interviewed to date
Participation rate: 88.3%

45. Rates of investigated cases of child maltreatment
Baseline Years

46. Rates of founded cases of child maltreatment
Baseline Years

47. Child injuries (hospitalizations and ER visits)
Baseline Years