Experience of implementing Triple P at a population level in Glasgow, Scotland

Wendy Toner Parenting Manager

Marie-Claire Leese Parenting Manager

Fiona MacKay Head of Planning and Health

Improvement

Linda de Caestecker Director of Public Health

Implementing Triple P in Glasgow

THE CITY

The ‘Grim Reaper’s Road map’

Source: Identity in Britain, University of Bristol

Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Scotland in Europe

Making the case

The importance of early years in addressing

inequalities

Tackling health inequalities

• Strong national early years policy

• Many other initiatives and programmes to promote

child well-being

• Child and Family teams in NHS working closely with

Education and Social Work and voluntary sector

• And yet……Child Protection Inspections identified

deficiencies in early intervention

Making the case

• Evidence from Triple P research

on reducing behavioural and

emotional problems; children in

care; parental stress; cost-

effectiveness and recent studies

on parenting support mitigating

against the effect of poverty

• Evidence from national surveys

on access to parenting support

• Led by public health to ensure

population level approach

Why we can’t do it in Glasgow……

• We do it already (show us the data/prove it)

• Not a Scottish programme (but it works)

• We need clinical freedom (go back to the

evidence)

• Our families won’t do groups (yes they do –

see voluntary organisations and smoking

cessation)

• We are too busy (hamster wheel)

• It’s not my problem (health inequalities are)

Implementing Triple P in Glasgow

Content of the Programme

Key elements of the Glasgow Framework

• Joint programme with Glasgow City Council (57,000 families)

• Dedicated staff to coordinate and support implementation of the parenting framework in each locality

• Triple P adopted as main parenting programme.

• Training existing staff - 1050 places over 3 years for multi-disciplinary staff.

• Evaluation

Nurseries and Schools

• Triple P seminars as part of

school induction

• Involvement of head teachers

essential

• Quality of delivery important

• Over 13,000 parents have

attended to date with majority

rating seminar positively

• Discussion groups in nursery

schools recently started and in

high demand

Partnerships between NHS and other

agencies • Glasgow Association of Mental Health

• Glasgow Housing Association

• Jeely piece club

• Triple P groups in local prisons -

• Families in Partnership

• Workplace Triple P

• Women’s Aid – groups in women’s

refuges

• Parents with addictions

• Large numbers of parents use Triple P

through libraries

Healthy Child Programme

• Link to National Child Health Surveillance

Programme with a new universal contact with

health visitors at 30 months

• Assessments for language development and

parenting issues using standardised validated

measures

• Referral to Triple P and language interventions

• Systematic use of Tip sheets at key

developmental stages

PATHWAY FROM CONTACT AT 30 MONTH INTO

TRIPLE P

30 month contact

Pervasive or more complex

developmental needs identified

Behaviour +/or communication

needs

Behavioural needs

Appropriate Triple P

Intervention

Communication needs

and behavioural needs

Multi agency intervention

and Triple P Group (L4)

Communication needs

only

SLT input and Triple P Tip

Sheet (L3)

The practicalities

Money and staff

Funding and Budgets

• Funding of approximately £2m, reducing to £500k, including evaluation.

• Shared costs and ownership, but need a host

• Use the cost calculator

• Transparency – regular financial updates to planning groups.

• Challenge to demonstrate the financial benefits

Proportions of staff trained by

discipline

The reality

Progress to date

1. The Media Campaign

The Universal Campaign in Glasgow

• Posters and media launch

• Leaflets and Newspaper in places

that parents go and through the

media

• Tip papers in school bags

• Web-site

Health News Magazine in local media

Information on how to access Triple P

Real stories

Triple P tips explained

Online version started

STV Microsite

• On-Air activity directs traffic to a Triple

P microsite on stv.tv

• Familiar to viewers

• Mirrors on-air exposure and easy to

navigate

• Information on how to access parenting

support

• General information about child health

•Parent testimonials and “Meet the staff”

The reality

Progress to date

2. Population Level Implementation

Programme reach (…as far as we can tell)

• Over 21,000 parents have received an

intervention (not including Tip Sheets)

• 1300 parents attended Group Triple P

• 1600 primary care interventions

……but we know this is an underestimate

The reality

Evaluation of Phase 1

Evaluation

• Activity data including demography and uptake

• Pre and post measures of child and parental

outcomes

• Population level measures of emotional and

behavioural difficulties at 2.5, 5, 7 and 10 years

• Evaluation of related pilots e.g. workplace, online

• Qualitative interviews with professionals and parents

Families receiving a Level 4 Group Triple P Intervention by

Scottish Index of Multiple Deprivation (SIMD) national quintile

Pre and post measures of group Triple P

• Data on 995 families

• 67% mothers

• 47% completion rate

• Only 50% of those who completed a group had post

measures

• Parental mental health, parenting problems and

quality of relationships all improved to a significant

degree

• If RTB methodology used very little change in the

scores

Evaluation objectives

• Pattern of emotional and

behavioural difficulties in the

population at key stages

• Overall changes in pattern

over time

• The extent that parents are

aware of Triple P and other

sources of parenting support

• The extent that offers,

uptake and completion of

Triple P match to level of

emotional and behavioural

difficulties

• The extent to which offers

uptake and completion of

Triple P influence the

persistence of difficulties

• The predictors of resolution

of difficulties both among

participants and more

broadly

Phase 1 Evaluation

• We are at the “get started, get better” phase

• High satisfaction by parents

• Baseline population level data

• Getting participants to complete the forms is

• a difficult task for many of our practitioners

• Starting to use improvement methodology (PDSA)

The reality

Challenges

Challenges

“Being challenged in life is inevitable, being

defeated is optional”

• Getting the right number of the right staff

trained, knowing who they are and who is

delivering with fidelity

• Engaging parents at all levels and having the

right pathways into Triple P

• Embedding practice in service delivery

• Communication and shared understanding

Challenges contd.

• Achieving a shared ownership and

understanding of local needs amongst

agencies

• Coordination of parenting support across a

large and complex organisation

• Effectively influencing and negotiating with a

large number of staff and managers

Case studies

Learning from real life

CASE STUDIES

Parenting managers

Case studies

• Work with Glasgow

Housing Association

• Partnership with

Early Years

Education Services

• Using Triple P with

families with

addictions

• Triple P in the

workplace

Next steps

Actions and way forward

Priorities for 2013

• Establish a coordinated, single process for

managing group referrals

• Improve uptake by using the 30 month

contact

• Improve referral to uptake and retention

• Design data collection and evaluation with

frontline staff

• Monthly newsletters

• Help practitioners to know they are valued

and supported in this endeavour