After a three year trial in Ireland's counties of Longford and Westmeath independent evaluation by the UNESCO Child and Family Research Centre at the National University of Ireland found Triple P interventions led to population-wide change, including reducing cases of children with clinically-elevated emotional and behaviour problems, by 37.5%. The outcomes showed that a pre-emptive public health program can have a huge impact on family wellbeing and entire communities benefit by enhancing traditional models of delivering public health.
During the project, Ireland suffered a severe financial crisis and dwindling public health resources. Simultaneously one in five of the county's children were showing behavioural and social problems. Conduct problems were trending even higher and parents were reporting high rates of depression.
A local public health service agency set out to make some major changes. Instead of parents queueuing for clinical services if things went wrong, the services would go to them first. Their mission was to improve the quality of life for all children and families by selecting an intervention built on strong research evidence and offering consumer choice.
Project Director and Services Psychologist Conor Owens:
After reviewing the literature we decided on the Triple P – Positive Parenting Program® with universal access and that's what we progressed with. We were lucky enough to get funding to roll that out over two counties.
The Longford-Westmeath Parenting Partnership was born with expertise from different levels of government and voluntary organisations. A small team began planning services for a population of 130,000 people and started training a core group of practitioners.
Project Co-ordinator Karen Heavey:
We planned delivery around where parents are located, where parents gather, and we looked to linking in with education centres, child care centres, community organisations and our partners that are involved with the partnership as well.
The Triple P programme incorporates five levels of intervention of increasing strength, each designed to suit a more narrowly defined target population. It allows parents to select the level of help they want. Those seeking a lighter touch can attend community seminars and those needing more help are offered group sessions over a period of eight weeks. Parents come away with strategies to prevent problems developing at home and also learn how to deal with some serious behavioural issues.
Triple P Practitioner and health promotion officer with the HSE Athlone Grainne Powell:
We’re not out to change the world. We start small and hone in. This is all about the parents’ concerns, how we can make Triple P fit for them, not the other way around … What I want is for parents to go away from the Workshop with the tools and techniques for keeping any situation calm.
In its evolved form, Triple P applies public health prevention strategies to the needs of children up to the age of 16 and amounts to a parenting and family support system of 25+ interlocking interventions. The design embodies the complementary concepts of ‘progressive universalism’ and ‘minimal sufficiency’. This means that the service is available to all, that those with the highest level of need receive the most support, and, as far as possible, that parents with different levels of need have the authority to self-select the support they require.
I think that was a hugely attractive piece combining prevention and intervention in the same program.
Initially there were some concerns about scarce resources that should go to targeted services, rather than universal access. With the evidence of the trial in hand health officials are now looking to scale up the delivery to other counties in Ireland.
Area Manager Midlands Health Service Joe Ruane:
Before the programme came to the Midlands we dealt with child, by child, by child, meeting clinician, after clinician, after clinician. The benefit of the Triple P programme is in providing an evidence-based program to the entire population. The one child that came in to see a psychologist for example, the benefit of the cost for that one hour versus the intervention support that could be delivered to a number of families is huge.
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