experience of implementing triple p at a population level...
TRANSCRIPT
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