Promoting Self regulation and relational competence in ... · Personality, sociability, maternal...
Transcript of Promoting Self regulation and relational competence in ... · Personality, sociability, maternal...
Transforming
Children’s Lives
Through Positive
Parenting
inMatthew R Sanders, Ph.D.
Parenting and Family Support Centre
The University of Queensland
November, 2018
Triple P Ontario Conference
• Disclosure statement• The Triple P-Positive Parenting Program is owned
by the University of Queensland. UQ licensed Triple P International Pty Ltd to disseminate the program worldwide
• Royalties are distributed to the Faculty of Health and Behavioural Sciences, School of Psychology, PFSC and contributory authors
• Professor Sanders is the founder, lead author and a consultant to Triple P International
How can
parenting
programs help
transform the
lives of children,
parents and
communities?
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Good parenting is the
clean water of child mental
health and well being
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Parenting has a pervasive impact
on development, learning and well being
Parent-child
relationship and
parenting
practices
Healthy brain development
Language,
communication, literacy
Executive functions
and self regulation
Academic attainment
Conduct problems/
antisocial behavior
Anxiety and stress
Attentional problems
Social skills and
peer relationships
Obesity
Chronic health problems
Pain management
Sedentary behavior
and physical activity
Screen time/
Online behavior
Moral development/values
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Consistent
assertive
discipline
Taking care
of oneself
A safe and
engaging
environment
Positive
learning
environment
Reasonable
expectations
Core
Principles
Why positive parenting is so important
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Effective
communication
with teachers/
carers
Being part of
the
community
Supporting
children’s
relationships
with peers
Balancing
work and
family
responsibilities
Maintaining
healthy
relationships
with extended
family
Other
positive
parenting
skills
Positive Parenting strategies
Children 2-12 years
Developing a positive
relationship
Encouraging desirable
behaviour
Teaching new skills and
behaviour
Promoting Self control
Brief quality time Praising children Setting a good example Establishing ground rules
Talking to your child Giving positive attention Using incidental teaching Directed discussion
Showing affection Providing engaging
activities
Using Ask, Say, Do Planned ignoring
Using Behaviour charts Clear, calm instructions
Logical consequences
Quiet time
Time out
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Parenting programs provide a context to influence
other determinants of parental capability
Cognitive factorsExpectations, beliefs,
attributions, knowledge
Relationship factorsSupport, conflict, violence
Economic factorsFinancial resources,
poverty, unemployment
Parental mental healthDepression, anxiety, substance abuse
Adverse life experiencesACE’s, trauma
Self regulationExec functions
Self management
Attention, impulse control
Cultural factorsReligion, cultural values,
mores, traditions, taboos
Characteristics of childrenTemperament, preterm, disability,
exposure to trauma
Biological
genetic influencesPersonality, sociability,
maternal health
Interactional
processesReciprocity, attachment
Parent
behavior
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Broader ecological context influences parents priorities
Parental
Engagement
- Discrimination
- Refugee status
- Type of Neighborhood
- Prior help seeking
- Level of violence
- Family of origin experiences
- Immigration status
- Culturally normative parenting
practices
- Education /literacy
- Laws
- Connectedness to community
- Parenting services
- Gender/age of parent
- Social infrastructure
- Employment status
- Poverty
- Government policies and
priorities
- Acculturation
- Parental mental health
Enablers & Barriers
Parental concerns -
Program itself -
Social context -
Cognitions or Affect
Expectations -
Motivation “Pull demand” -
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Child, parent and family problems and vulnerability
Parental
engagement
What child?• Developmental level
• Genetic vulnerability
• Prematurity
• Low birth weight
• Developmental
disability
• Type and severity
of behavior or
emotional problem
What parent?• Depression/anxiety
• High stress
• Couple discord
• Abusive parent
• Substance abusing
• Minority parents
• Indigenous parents
• Grandparent
• Foster parent
What Family?• Violent
• Separated/divorced
• Incarcerated
• Step/blended family
• Adoptive parent
• Single parent
• Teen parent
X X
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Population
approach
needed
Multi-level system
Multidisciplinary
Inclusive
Effective
Making it workCulturally appropriate
Different outcomes
13
A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Tailoring the Triple P experience
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• 164 RCT’s
• 96% show positive
effects
• 4% (13/321) report
null findings
• 52% have no
developer
involvement
But does it work?
International
dissemination begins
Program gets a
name
Publication of first
population trial
Building a foundation of evidence
N = 3 N = 2 N = 24 N = 2
How effective is Triple P?
N=16,009 families
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0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Level 1 Level 2 Level 3 Level 4 Level 5
Parenting practices
overall d=.58
Child outcomes
overall d=.47
Me
diu
mS
ma
ll
Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34(4), 337-357.
Larg
e
Comprehensive evaluation requires different types of
evidence
Service-based evaluations (e.g. Santa
Cruz, 2015)
Consumer preference studies
(Metzler et al, 2013)
Training, implementation and
supervision studies (Hodge et al,
2016)
Program evaluations in diverse
cultures (Sumagi et al, 2015)
Qualitative studies (Frank et al, 2015)
• Conceptual papers (Sanders & Kirby,
1994)
• Single-case experiments (Sanders &
Glynn, 1981)
• RCTs (Sanders et al, 2000)
• Place based RCT’s (Prinz et al, 2009,
2016)
• Quasi-experimental studies (Zubrick et
al,1995, Fives et al, 2015; Doyle et al, 2018)
• Evaluations in LMIC (Mejia et al, 2014)
• Multiple meta analyses (Sanders et al,
2014; Nowak & Heinrichs, 2008)
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Positive parenting programs work with many
different types of children/ target problems
Different types
of children/
problem
behavior
Severe feeding
problems
ADHD
Recurrent
abdominal pain
Anxiety disorders
Gifted and talented
children
Conduct problem
adolescents
Children in natural
disasters
Children victimised
by peers
Children with ASD or
IDD
Children at risk
of abuse
Children with
trauma histories
Children with chronic
health conditions
Conduct problems
Sleep problems
Habit disorders
Mealtime problems
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Successful population-level interventions blend
universal and targeted programs
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Three strategies to transform lives
1. Promote self regulation
2. Enhance relationship
capability
3. Activate community
support
Key themes
What is self regulation?
Self regulation defined by Karoly (1993) as:...those processes, internal and or transactional, that enable an individual to guide his/her goal directed activities over time and across changing circumstances (contexts). Regulation implies modulation of thought, affect, behavior or attention via deliberate or automated use of specific mechanisms and supportive metaskills.
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Self-
management
tools
Self-efficacyPersonal
agencySelf-sufficiency
Self-regulation of behavior
Minimally sufficient intervention Red
uced
need
fo
r su
pp
ort
Promote Parental Self-regulation
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Self regulation underpins ability to parent children well
• Has a clear sense of purpose
• Knows what behaviors, skills and
values to promote as a parent
• Has realistic expectations
• Self-monitors automatically, rather
than consciously or deliberately
• When personal standards/values are
violated she brings current behavior
under personal control
• Tunes into her own actions and
searches for explanations
• Uses her knowledge to develop plans
• Carries out plan and revises as needed
• Expects to be successful and bring
about good outcomes
• Is reflective, capable of identifying
strengths and weaknesses, without
being unhelpfully self critical
• Reflections increase her self efficacy
and personal agency
• Mostly enjoys the process
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Stress disrupts parents capacity to self regulate?
Brief increases
in heart rate
Mild elevations in
stress hormonesPositive
Serious, temporary
stress response
Buffered by
supportive
relationshipsTolerable
Prolonged
activation of stress
response systems
In the absence of
protective
relationshipsToxic
• Brain development,
structure, and function
• Behavior
• Immune function
• Gene expression
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Reduce Adverse Childhood Experiences
(ACEs) to enhance Life Course Outcomes
Types of ACE’s
ABUSE• Physical
• Emotional
• Sexual
NEGLECT• Physical
• Emotional
HOUSEHOLD DYSFUNCTION• Mental Illness
• Incarcerated relative
• Mother treated violently
• Substance abuse
• Divorce
• 12.2 times as likely to attempt suicide
• 10.3 times as likely to use injection
drugs
• 7.4 times as likely to be an alcoholic
• 2.4 times as likely to have a stroke
• 2.2 times as likely to have ischemic
heart disease
• 1.9 times as likely to have cancer
• 1.6 times as likely to have diabetes
A person with
any 4 or more
is….
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Benefits of Positive Parenting for Parents
• Increased self efficacy
• More positive interactions (calmer homes)
• Better relationships with children
• Less conflict with their children (harsh, coercive discipline)
• Less conflict with partners
• Better functioning at work (work-home conflict)
• Less depression
• Less stress
Parenting
skills
SR and
Life skills
• Promoting a positive
relationship
• Encouraging desirable
behavior
• Teaching new skills and
behavior
• Teaching children self control
• Self management skills
• Emotion regulation skills
• Attribution retraining
• Teamwork/ Partner support
• Self care
• Healthy lifestyles
Better
parental
self
regulation
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Three strategies to transform lives through positive parenting
Promote self regulation
Enhance relationship
capability
Activate community support
for parenting
Key themes
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Enhancing
relationship skills
of parents and
children
Parents
Parent/sSanders & Mazzucchelli (2018)
GrandparentsKirby & Sanders (2014)
SiblingsPickering & Sanders (in press)
PeersHealy & Sanders (2014)
Teachers/ECE/Carers
Children
Transforming the lives of children and parents
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Poor
relationships
adversely affect
children’s well
being
Lack of
modeling and
reinforcement of
prosocial
behavior
Poor social skills
Poor conflict
management
Poor emotion
regulation
Increased risk of
social, emotional
and behaviour
problems
Grand parents and
kinship carers
Parent/s
Children’s teachers/carers/
coaches
Peers/Siblings
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Enhancing children’s relationships to reduce bullying
Parenting influences
children’s peer relationships,
social skills, emotional
regulation and sibling
relationships.
School bullying
has severe
consequences
Depression
Lower
self-esteem
Anxiety
Loss of
friendships
Suicide
Behaviour
problems
Health
problems
School
absenteeism
Increased long-term risk
of severe mental health problems,
school dropout, involvement in
criminal justice system
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Specific child and parent skills targeted
Child social and emotional skills
• Play skills (joining, sharing, turn taking)
• Everyday body language
• Responding calmly and
assertively to provocation
(verbal and non-verbal skills)
- Resolving conflicts
• Interpreting peer situations
• Self-regulatory skills
Facilitative Parenting skills
• Being warm and responsive
• Enabling appropriate independence
• Supporting children’s friendships
• Coaching and enabling children’s
problem solving
• Resolving conflicts effectively in
the family
• Maintaining good communication
with the school
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Summary of findings
• At 9 month follow up compared to active controls, intervention children
experienced
(mostly medium effect sizes)
- Less bullying (child, parent, teacher report)
- Less depression
- Less aggression
- Improved social skills
- Greater liking of school
- Greater liking of same and opposite sex peers
- Less distress from peer behavior
• High levels of program satisfaction from both parents and children
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Strategies to transform lives
Promote parental self
regulation
Activate community support
Key
strategiesEnhance relationship
capability
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Harsh, Coercive
Parenting
Parental Self
Efficacy
Positive
Parenting
Parental
TeamworkFamily Conflict
Parent
Wellbeing
Leads to Better
Child Outcomes
Implementation of
multi-level system of
parenting support
Community
Social Capital
Social Cohesion
and Trust
Social Support
for Parenting
Collective
Efficacy
Creates positive
changes in
parenting and family
relationships
Activates community
processes that
support parenting
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Better Child
Outcomes
Reduced child
maltreatment
Better mental
health
Improved school
outcomes
• Fewer cases of child abuse and neglect
• Lower rates of child abuse related
hospitalizations and injuries
• Fewer out of home placements
• Lower rates of serious behavioral and
emotional problems
• Reduced risk for antisocial behavior,
substance abuse, serious mental
health problems
• Improved academic attainments
(literacy-numeracy)
• Fewer conduct problems at school
• Lower rates of truancy
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A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Parenting and Intergenerational disadvantage:A population trial of the Triple P system of parenting and family support
Chief Investigators
Professor Matthew Sanders
Professor Michele Haynes
Professor Stephen Zubrick
Professor JaneenBaxter
Professor Mark Western
Associate Investigators
Dr Kylie Burke
Mr Francis Mitrou
Professor Ron Prinz
Assoc Prof Alina Morawska
Dr Bernie Baffour
Dr Orla Doyle
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A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Communication
strategy
Destigmatize Validate
EmpowerNormalize
“Stay Positive”
Engaging the media
45
A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Level 2: Triple P
Seminar Series
Seminar 1
Power of Positive
parenting Seminar 2
Raising confident,
competent children
Seminar 3Raising resilient
children
90 minuteLarge group seminars
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A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Parent Discussion Groups
(Single session low intensity group
interventions)
50
A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
51
A multi-level system needed “Avoid one size fits all”
Intensive family intervention
Broad focused parenting support
Level 5 Individual, Group
Breadth of reachIn
ten
sity
of in
terv
en
tion
Narrow focus parenting support
Brief parenting advice
Communication strategy
Level 4 Individual, group, self help, online
Level 3 Individual, group, online
Level 2 Individual, group
Level 1 Universal level
Medium
and high
intensity
Low
intensity or
“light touch”
Very low
intensity
Life skills Triple P
Combining parenting and life skills training
Parenting
skills
Self
Regulation
and Life
skills
• Promoting a positive
relationship
• Encouraging desirable
behavior
• Teaching new skills and
behavior
• Teaching children self control
• Self management skills
• Emotion regulation skills
• Attribution retraining
• Teamwork/ Partner support
• Self care
• Healthy lifestyles
Life Skills
Triple P
The single most important thing we can
do to improve the well being and life
opportunities of children is to increase
the knowledge, skills and confidence of
all parents in the task of raising their
children
54
Future of evidence-based parenting support
• Ongoing innovation
(e.g. environment, radicalisation, home-school communication, parenting and sport, animal
welfare, intergenerational relationships, global violence reduction)
• Understanding non-responding and mechanisms of change
• More research on dissemination and implementation (e.g. AI-
assisted online professional training, supervision)
• Keep improving positive parenting techniques (e.g. Salmon et al, 2013).
Key features of a
“family friendly”
community
What’s newNew Programs to be
Disseminated
Revised Every Parent Survival Guide Video-
all levels
Resilience Triple P (Level 5)
Lifestyle Triple P seminar series(level 2)
Fear Less Triple P (Level 4)
Positive Early Childhood Education Program
(PECE)
Baby Triple P (Level 4)
Some Programs in Development
Building Bridges Triple P (Level 3)
Life skills Triple P (Level 5)
Alliance of Parents and Teachers (APT)
New Books
Sanders, MR & Mazzucchelli, T.G. (Eds).The
Power of Positive Parenting: Transforming
the live of children, parents and
communities. Oxford.
Sanders, M, & Morawska, A. (Eds).Handbook
of Parenting and Child Development
Across the Lifespan. Springer.
57
Population level
change is an
achievable goal
Participation becomes
socially normative
Positive parenting
becomes a policy priority
and is funded accordingly Parenting
support is an
essential to the
prevention of
child problems
Key Take Outs
58
KEY QUESTION REVISITED
Can we really
transform
children's lives
in a meaningful
way?
Happier, healthier, better
adjusted children,
parents and communities
Yes we
can…
Thank you
for your attentionfor more information pfsc.uq.edu.au (R & D)
triplep.net (training, dissemination,
implementation support)
tprn.net (research network)
Twitter @drmattsanders