Triple P OnlineUse of a self-directed online parenting programme to increase reach and improve impact for vulnerable families

Matt Buttery & Ronan Fox

The next 15 minutes…

• Parenting and health outcomes – a quick overview

• What is Triple P and why online

• Case study 1 – North Staffordshire CAMHS

• Case study 2 – London Borough of Barking & Dagenham

• Case study 3 – At scale in Ireland and in Queensland, Australia

Prevalence of conduct disorders

3https://www.centreformentalhealth.org.uk/publications/children-new-millennium

https://www.centreformentalhealth.org.uk/publications/children-new-millennium

Conduct disorders as a future predictor of problems

• 850,000 children and young people have some form of clinically diagnosable mental health disorder

• Over half of these children have conduct problems - regarded as the single most powerful predictor of mental health problems in adulthood

• Parenting interventions such as Triple P have the greatest evidence of being able to address conduct problems

• Most parents of children seek help, usually from schools or their GP

• Only a quarter get any help

Department of Health, NHS England. (2015). Future in mind. Promoting, protecting and improving our children and young people’s mental health and wellbeing. London, UK: Department of Health

Building a Better Future, (2014). Centre for Mental Health

NICE Guidance

• Triple P is one of only two evidence-based programmes recommended by NICE:

- As recommended treatment for conduct disorder in children under eleven and first-line treatment for ADHD in children under five

- For parents of children aged under 12 years with a Learning disability and behaviour that challenges (Stepping Stones Triple P)

- As early help for families showing possible signs of Child Abuse and Neglect

National Institute for Health and Clinical Excellence. (2008). Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. Retrieved from: guidance.nice.org.uk/cg72

• Flexible system of interlocking parenting and family support programmes

• Birth to 16, and children with a disability (Stepping Stones Triple P).

• Blended universal and targeted approach

• Combines prevention, early intervention and targeted delivery

• Multi-disciplinary focus

• Can scale to a public health model of parent education and support

• Evidence-based

• Self-regulatory framework

The Triple P System

Triple P: One of the most evidence-based parenting programmes in the world

• Outcomes of NICE compliant evidence based parenting programmes include:- Improved child behaviour in children with ADHD and conduct problems- Improved child emotional wellbeing- Greater parental confidence, and less negative parenting, stress, depression, and anger.- Less adult couple conflict over parenting

• Triple P is regarded by The World Health Organisation’s violence prevention briefings as one of two programmes having the strongest evidence to prevent child maltreatment.

• Triple P Online has shown mental health outcomes for both children and parents, including pre-school children whose ADHD symptoms were reduced.

• An independent evaluation in Ireland shows population-health outcomes for children’s and parents’ mental health, replicating findings for the original Brisbane population-health study.

Why Online?...

Percent indicating ‘quite’ or ‘very interested’ in receiving parenting information in each of nine formats (N=158)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

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clinical nonclinical

Metzler, C. W., Sanders, M. R., Rusby, J. C. & Crowley, R. N. (2012). Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support. Behavior Therapy, 43, 257-270.

…parental preference:

IPSOS Mori research 2018 in Queensland:

Chart1

TV programTV program

Online programOnline program

Written materialsWritten materials

One-time workshop/seminarOne-time workshop/seminar

Self-paced workbookSelf-paced workbook

Resource centerResource center

Group/class, several weeksGroup/class, several weeks

Sessions with therapistSessions with therapist

Home visitsHome visits

clinical

nonclinical

0.776

0.573

0.647

0.561

0.588

0.402

0.518

0.39

0.518

0.354

0.424

0.244

0.318

0.22

0.318

0.085

0.247

0.11

Sheet1

MEANSPERCENTS

clinicalnonclinicalclinicalnonclinicalTotal SampleXsquarePvalue

parenting group weeks2.90242.5775TV program77.60%57.30%67.70%7.884080.00499

one time parenting group3.55563.1831Online program64.70%56.10%60.50%1.293960.25532

home visit2.58752.1127Written materials58.80%40.20%49.70%5.763230.01636

online3.9633.8732One-time workshop/seminar51.80%39.00%45.50%2.731840.09837

tv program4.30863.942Self-paced workbook51.80%35.40%43.70%4.561690.03269

workbook3.5753.1127Resource center42.40%24.40%33.50%6.042010.01397

resource center3.25612.8696Group/class, several weeks31.80%22.00%26.90%2.041850.15302

therapist2.63412.0704Sessions with therapist31.80%8.50%20.40%13.888230.00019

written material3.79273.3521Home visits24.70%11.00%18.00%5.339070.02085

Sheet1

clinical

nonclinical

Sheet2

clinical

nonclinical

Percent indicating "quite" or "very interested" in receiving parenting information in each of nine formats

Sheet3

What is Triple P Online?

A stand-alone web-based intervention (equivalent to Level 4 Standard Triple P) designed to promote positive parenting practices and teach parents the application of principles to specific situations. Parents can complete the program in their own time on a computer, tablet, or smartphone. Key features:

• Mentor introduces and summarises modules

• Video clips of families in action

• Interactive exercises

• Individual goal setting, feedback and weekly check in

• Downloadable worksheets and podcasts

• Personalised and printable parent workbook

• Review and reminder strategies (text messages, emails)

Case Study 1North Staffordshire CAMHS

Meet Deborah

https://www.youtube.com/watch?v=koWlzJgTRbE

https://www.youtube.com/watch?v=koWlzJgTRbE

Triple P and North Staffordshire CAMHS

• 52% of referrals are for behavioural or neurodevelopmental issues

• They see around 500 families a year, some of whom are referred to TPOL

• This represents only a very minor number of families who need help. And waiting lists for CAHMS services are notorious.

First CAMHS appointmentWaiting list

Treatment

Triple P onlineTriple P

online

Triple P online

Case Study 2London Borough of Barking & Dagenham

Reaching parents earlier with online

14

Barking and Dagenham geo-located Triple P landing page

Triple P Online (TPOL) codes

Primary Schools CAMHS

Triple P Lvl 2 Seminars & Lvl 3 Discussion Groups delivered by

school and LA/Third Sector

CWP’sTriple P

Lvl 2, 3 & 4

‘Core’ CAMHS

Lvl 4 Triple P

Flyer Word of mouthSchool

seminar GP CAMHS A&EInpatient

s

Implementation

15

• 11 school practitioners trained to deliver seminars and discussion groups in pilot primary schools

• 11 CAMHS practitioners trained to deliver seminars and discussion groups, also more intensive small group sessions

• Triple P Online - access for 500 parents, dedicated landing page, marketing and communications campaign (digital and traditional)

www.triplep-parenting.net/lbbd

Results so far – 6 months in

• Successful delivery of seminars and discussion groups in pilot schools and signposting to online –positive feedback from practitioners and parents

• CAMHS – very little delivery to date

• Triple P Online – 167 parents have accessed so far:

- 30% heard about it from their school, 38% from online search / advertisement

- It is reaching parents with clinical levels of concern about their child (as measured by the SDQ)

- Parents who responded reported large improvements in their confidence dealing with issues identified at the outset

16

0-12 Triple P Online:

Teen Triple P Online:

Lessons learned and next steps

• Schools are an effective way of reaching parents with ‘light touch’ parenting interventions and signposting to Triple P Online – when the challenges of capacity and commitment can be overcome

• CAMHS as an effective delivery route is unclear – the barriers to delivery so far are to be explored further

• Triple P Online can reach more families – the communications campaign is to be stepped up to achieve this

• Local co-ordination is key - long term sick leave significantly impacted delivery

17

“I recently joined the online Triple P course as a result of attending the course in school. I feel it has really helped me and my family

solve our problems regarding my son’s behaviour. It has given me the confidence to share my new

skills with my family and friends. I have even recommended the Triple

P to them”

Anonymous parent - Barking and Dagenham, 2019

Case Study 3At scale in Longford & Westmeath, Ireland and in Queensland, Australia

Going to scale and getting results in Longford and Westmeath, Ireland

http://www.atlanticphilanthropies.org/learning/report-parenting-support-every-parent

http://www.atlanticphilanthropies.org/learning/report-parenting-support-every-parent

Going to scale and getting resultsin Queensland, Australia

• Implementation: - Public health approach - Stepped care / proportionate universalism- Delivered through a range of partners- Practitioner Training, resources & online tools - “Fast Start” seminars- Marketing and communications campaign

• Over 135,000 parents and carers families have accessed Triple P in 2-year period

• Nearly 30,000 of these families accessed Triple P Online, with an over-representation of:- Single parents (20.4% compared with 16.1% in Qld population)- Parents on a low income (those who hold a Health Care Card – 26.3% compared with 20% in Qld population)- Parents speaking English as a second language (14.9% compared with 7% in Qld population)

• Many of the families accessing Triple P Online reported clinically-significant levels of disruptive child behaviour and adult mood disorders (depression, stress)

Further information

• Visit our stand for a free Triple P Online demo code

• General information

- www.triplep.net

- http://www.pfsc.uq.edu.au/research/evidence/

• Matt Buttery - Chief Executive - Triple P UK & Europe

- matt.buttery@triplep.net

• Ronan Fox – Joint Children’s Commissioner – Barking & Dagenham CCG

- ronan.fox@nhs.net

http://www.triplep.nethttp://www.pfsc.uq.edu.au/research/evidence/mailto:matt.buttery@triplep.netmailto:ronan.fox@nhs.net

Triple P OnlineThe next 15 minutes…Prevalence of conduct disordersConduct disorders as a future predictor of problemsNICE GuidanceSlide Number 6Triple P: One of the most evidence-based parenting programmes in the worldWhy Online?...What is Triple P Online?Case Study 1Meet Deborah Triple P and North Staffordshire CAMHSCase Study 2Reaching parents earlier with onlineImplementationResults so far – 6 months inLessons learned and next stepsCase Study 3Going to scale and getting results �in Longford and Westmeath, IrelandGoing to scale and getting results�in Queensland, AustraliaFurther information