Implementation and Cost Benefits of the Triple P System

Ron Prinz, Ph.D.Carolina Distinguished Professor

Director, Parenting and Family Research CenterUniversity of South Carolina

The Triple P Positive Parenting Symposium

A Promising Strategy to Reduce Child Maltreatment

December 8, 2009

Parenting and family support that is:

Cost EffectiveAND

Population Wide

Is this a contradiction of goals?

Population-wide dissemination requires:

• Multi-level parenting intervention• Evidence-based programming• Efficient parenting intervention designed

specifically for population-based dissemination

.

Triple P System of Parenting Interventions

Universal strategy

• Does not have to mean every family gets intensive intervention or even non-intensive face-to-face programming

• Triple P emphasizes universal access to evidence-based parenting information, not 100% direct service delivery

Combine strategies for efficiency

Blending of:

-- Universal prevention

-- Selected prevention

-- Indicated prevention

-- Early intervention

-- Treatment

Achieve multiple goals with same parenting intervention• Prevention of children’s social, emotional and

behavioral problems• Prevention of child maltreatment (abusive

parenting)• Promotion of healthy child development,

readiness for school• Family-based treatment of child mental-health

problems

Ways to get more out of a population approach

Media strategies

• Why should individual practitioners care about Triple P media strategies?

• Parental receptivity– Normalize seeking of parenting/family support– De-stigmatize participation– Stimulate interest and action

• Validate positive parenting• Reinforce practitioners• Extend practitioners’ work

Media Coverage

Media strategies

• Multiple publicity strategies– Press releases linked to local interests– Reporter-initiated news stories– Positive parenting articles– Radio public-service announcements (PSAs)– Community events– School newsletters, other mailings– Bumper stickers, memorabilia

• Involve larger numbers of parents in lower program levels (e.g., parenting seminars)

Role of practitioner is critical

• Triple P is a framework and comprehensive set of tools

• Triple P is NOT a cookbook• “Manual with a brain”• Don’t leave your communication and analytical

skills at the door• Beyond training:

– Self-regulation of professional development– Peer support networks (to learn from peers)

“It Doesn’t Work with My Families”

• The “It” (Triple P) is a framework with many different “ITS”

• Same thing is sometimes heard in schools: – “Some children cannot learn”– “I cannot get through to this child”

• When faced with challenging situations:– Focus heavily on process– Utilize supervisory and peer support resources– Simplify the initial goals– Make sure that a mandate from the parent has been

achieved

Peer support networks

• Within and across agencies• Diversity of client populations is good• Collective problem-solving• Expanding your repertoire

Parents as consumers

• Let parents in the community know about Triple P (even if your organization doesn’t work directly with your network of parents)

• Involve parents and parent advocates in community planning committees

• Document parental opinions about Triple P

Triple P as value added

• Triple P is not meant to supplant other kinds of services

• Child trauma treatment• Substance abuse treatment of parents• Housing, health care, and sustenance needs

Population dissemination

• Can be several systems at once• Or, incremental• Complete population dissemination:

– An ideal to strive for– Not an end state– Find the levels of penetration sufficient to produce

positive changes in prevalence of target problems

Cost and benefit considerations

Summary cost

• Population that includes100,000 families• Cost of Triple P system dissemination

infrastructure:– Per child birth to 12 years

$11.74 cost per child

Cost basis

• Population of approximately 500,000 people• Costs included:

– All levels of Triple P training– All practitioner materials– Pre-training consultation– Post-training consultation and support– Implementation of media strategies

• Costs not included:– Parent resource materials– Workforce itself

Potential benefits and cost offsets

Estimating impact on child abuse

www.paxis.org/triplep

Estimator for U.S. states

Not yet calibrated for Canada, but gives general sense of cost offsets

Triple P Prevention Estimator

• Apply population-trial effects to other geographic areas

• Example: Florida• FL Pop: 1,977,541 children birth to age 9• FL Child Maltreatment: 89,072 cases in 2006• FL Out of Home Placements: 10,421

placements in 2006

Triple P Prevention Estimator

• Select tab “Out of Home Placements”• Set the $ value for annual cost of one out-of-

home placement (let’s choose $18,000)• If population preventive effects occurred in

Florida, this would result in:– Reduction of 2,657 placements in a year– Savings of $47,832,390 in a year ($18,000 times

2,657)

Triple P Prevention Estimator

• If the effects in Florida were half as strong as those found in the population trial, then:– Out-of-home placement savings would be

$23,916,195 in a year

• Express the anticipated savings as a range:– Between $23 and $47 million annually for out-of-home

placements

Not Included in Savings Estimate

• Long-term cost offset in terms of sequalae of child maltreatment

• Reduction of children’s social, emotional, behavioral, and health problems (general population)– Short-term reduction of services costs– Long-term cost offsets

Sources of efficiency

• Utilize existing workforce across many settings, agencies, and providers

• Combine goals that have in common parenting intervention

• De-stigmatize participation by parents• Parenting interventions designed for population

dissemination• Build on evidence-based system of interventions• Use the tiered model that draws on media and

low-intensity interventions as the base

Conclusions

1. Dissemination of the Triple P system has produced clear impact on prevalence of child maltreatment at a population level

2. First time ever that a population randomization trial on child maltreatment has been conducted and yielded preventive effects

3. Cost effectiveness of the Triple P population approach grounded in several sources of efficiency

Key References

Results of U.S. Triple P System Population Trial:Prinz RJ, et al. (2009) Population-based prevention of child maltreatment: The U.S. Triple P

System Population Trial. Prevention Science, 10, 1-12.

Cost considerations:Foster EM, et al. (2008). The costs of a public health infrastructure for delivering parenting and

family support. Children and Youth Services Review, 30, 493-501.

Mihalopoulos C , et al. (2007) Does the Triple P—Positive Parenting Program provide value for money? Australian and New Zealand Journal of Psychiatry, 41, 239-246.

Overview of Triple P and evidence base:Sanders MR (2008) Triple P—Positive Parenting Program as a public health approach to

strengthening parenting. Journal of Family Psychology, 22, 506-517.

Nowak C & Heinrichs N (2008) A comprehensive meta-analysis of Triple P—Positive Parenting Program using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114-144.

ESTIMATOR for cost savings (child maltreatment prevention) http://www.paxis.org/triplep