The Positive Parenting Program (Triple P)

First 5 Santa Cruz County

Commission Meeting

September 22, 2010

www.first5scc.orgPrepared by Optimal Solutions Consulting

www.opti-solutions.com

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.

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

5 Principles of Positive Parenting

1. Ensuring a safe, engaging environment

2. Creating a positive learning environment

3. Using assertive discipline

4. Having realistic expectations

5. Taking care of yourself as a parent

An Ecological Approach

System

Community

Family

Individual

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

Minimal Sufficiency

Universal

Selected & Seminars

Primary Care

Standard & Group

Enhanced &

Pathways

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

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

17 Core Parenting Skills

Promoting Positive Relationships

Encouraging Desirable Behavior

Teaching New Skills &

Behaviors

Managing Misbehavior

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

Pilot Plan – Year 1 (FY 2009-10)

Level 4 - Group & StandardLevel 5 - Enhanced & Pathways

Level 3 - Primary Care

•Children’s Mental Health•Familia Center•Families Together•Head Start•La Manzana Community Resources•Parents Center

• Children’s Mental Health• Dominican Pediatrics• Familia Center• Head Start/Early Head Start• LMCR• Mountain Community Resources• Parents Center• SC Women’s Health Center• Women’s Crisis~Defensa

Total: 18 Total: 40

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

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

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

Parent’s Perception of Child Behavior (Intensity)

Series136

72

108

144

180

216

252

125.5

85.8

Pre Post

Clinical Cut-Off:>= 131

Behavior always occurs

Behavior never oc-curs

n = 29

Parent’s Perception of Child Behavior – (# of Problems)

Series10

6

12

18

24

30

36

15.3

7.4

Pre Post

Clinical Cut-Off:>= 15

All behaviors were a problem

No behaviors were a problem

n = 30

Parent’s Perception of Child Behavior - % in Clinical Range

Intensity Problem0%

10%

20%

30%

40%

50%

40%

45%

10%

21%

Pre Post

Parenting Style

Overall Laxness Over-Reactivity Hostility1

2

3

4

5

6

7

3.12.9

3.1

1.6

2.62.4

2.7

1.4

Pre PostDysfunctional Parent-ing Style

FunctionalParenting Style

Clinical Cut-Off:>= 3.2

Clinical Cut-Off:Females >= 3.6Males >= 3.4

Clinical Cut-Off:Females >= 4.0Males >= 3.9

Clinical Cut-Off:Males >= 3.5Females >= 2.4

n = 33 n = 33n = 32 n = 32

Parenting Style – % in Clinical Range

Overall Laxness Over-Reactivity Hostility0%

10%

20%

30%

40%

50%

39%

31%

21%

13%

27%

13%

9% 9%

Pre PostDysfunctional Parenting

FunctionalParenting

Parenting Confidence

Setting Self-Efficacy Behavioral Self-Efficacy 0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

86.1

75

92

88

Pre Post

Clinical Cut-Off:<= 79.3

Clinical Cut-Off:<= 68.4

Certain I can do it

Certain I can't do it

n = 34

Parenting Confidence – % in Clinical Range

Setting Self-Efficacy Behavioral Self-Efficacy 0%

10%

20%

30%

40%

50%

0.24

0.32

0.06 0.06

Pre Post

Client Satisfaction – Overall

Parent's opinion of child's behavior at completion of program

Program helped parent develop skills that can be applied to other family members

Program helped parent deal more effectively with problems in family

Program helped parent deal more effectively with child's behavior

Parent received type of help wanted from program

1 2 3 4 5 6 7

5.97

6.18

6.09

6.34

6.06

Building a Sustainable Model for Funding & Service Expansion

• Level 2 Individual• Level 3 Primary CareFunders pay for training & materials only

Agency provides services with existing funding

• Level 2 Seminar• Level 3 Primary Care• Level 4 Standard/Group• Level 5 Enhanced/Pathways

Funders pay for training, materials & services

(contract or fee-for-service)

• Level 4 Standard/Group• Level 5 Enhanced/PathwaysFunders pay for training & materials

Parent pays for services

(Practitioner sets fee or bills insurance)

Leveraging Funding

First 5 Santa Cruz County

Health Services Agency

(MHSA - PEI)

Human Services

Department

(Title IV-E Training)

Triple P America

Coordination

Fee-for-Service

Contracts with Agencies