The Triple P Child Welfare Controversy: A Measure of Hope
A recent article in The Atlantic by Olga Kahzan reported on the controversy surrounding Triple P. Many of you have heard of the Triple P – Positive Parenting Program ®. This is one of a number of models for supporting families to improve their parenting skills to develop more nurturing relationships and sensitive interactions with their children. Triple P is also one of the most extensively researched programs.
Triple P aims to prevent emotional and behavioral problems and create a positive family environment for children to thrive. It was developed using a public health perspective to provide interventions geared to multiple levels of need, ranging from community awareness of positive parenting, to seminars and group classes, to home-based family intervention. There are also Triple P variations designed for targeted populations, such as families of children with special needs, those who are overweight, teenagers and families experiencing separation/divorce. Organizations may choose the levels and variations that fit their communities’ needs. Triple P claims an advantage over other family support programs due to this flexible range of service intensity, a broad evidence base, and a large scale of dissemination in 25 countries.
The Atlantic article reported on the challenges of evaluating the outcomes of Triple P group classes with families involved in the Child Welfare System. The title alone is compelling: Welcome to Parent College: Can parenting classes help end America’s disgraceful child-abuse epidemic? This question stems from heated debates about criticisms of Triple P evaluation studies between Triple P developers and independent researchers on the effectiveness of Triple P interventions. We don’t have room here to go into the debate in detail, but I would like to offer one idea.
How Do You Prove a Negative?
When the goal is prevention of neglect and abuse, some struggle with the concept of evaluation. Evaluation of family support programs is essential, but can be complicated [LINK – www.theounce.org/pubs/HomeVisitation.pdf]. This is especially true when serving families involved in the Child Welfare System who are experiencing multiple life challenges. It behooves every family support program, no matter how strong the evidence base of the service model, to evaluate their outcomes to assess how well they are achieving their stated goals. The Atlantic article provided a good example:
“So does Triple P work? As Katie Albright, the director of the San Francisco [Child Abuse Prevention] Center, mused . . . “How do you prove a negative?” For any given family, is it possible to know whether Triple P was what stopped them from hitting their kids? Unless welfare agencies make Triple P or a similar program mandatory, parents can refuse the intervention. Even when they attend faithfully, no one really knows whether parents put into practice what they learned.”
(Khahzan, Welcome to Parent College, The Atlantic, March 14, 2016)
You Need an Intermediate Measure
This San Francisco Center Director identified a major pitfall of many program evaluations. Measuring outcomes in terms of the absence of something, such as the lack of injuries, emergency room visits or child abuse reports, is thorny due to the hopefully small number of reports of abuse or neglect, differences in definitions, changes in local reporting requirements or policies, as well as confidentiality regulations. A more timely and logical measure of outcomes is needed to evaluate a parenting intervention. Triple P, and most other prevention programs, aims to prevent or reduce abuse by changing parents’ behaviors. Thus the evaluation needs to include an intermediate measure of parenting behavior. Knowing if the program is successfully changing behavior is important in determining the success of the program. An observational assessment of the change in each parent’s interactions with his/her child would demonstrate whether the parent can apply what was learned in the parenting classes to everyday life.
Measuring outcomes like abuse reports are removed in time from intervention. If one intervenes to change parent behavior, one could measure the immediate impact of the intervention. One could also assess if the changed behavior persists. Furthermore, one could use the information to guide the intervention. Parents not responding as expected could be offered different supports.
With an assessment of parenting behavior, like KIPS, one can determine if the intervention is changing behaviors. One study at the University of South Carolina found that Stepping Stones Triple P (Level 4) did change parenting behavior for the better. Unfortunately, one cannot easily extrapolate from one small study in South Carolina with families of toddlers with special needs to other populations. If the programs described in The Atlantic article had used an intermediate measure, then much light could have been shined to understand the impact of Triple P parenting classes on families involved in the Child Welfare System.