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Helping Families Change Conference 2015, February 25th

Irene Sies (Het ABC)

Marion van Bommel en Jolyn Berns (The Netherlands Youth Institute)

Successful implementation of Triple P

in the Netherlands

© Copyright University of Queensland 2011

Jolyn

Irene Marion van Bommel MSc

Introduction

• Do you know Triple P?

• Relation to Triple P?

• Implementation phase?

Overview

• Triple P in the Netherlands

• Implementation of Triple P in Amsterdam

• What do we know about successful

implementation?

• Visualization results

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Overview

• Triple P in the Netherlands

• Implementation of Triple P in Amsterdam

• What do we know about successful

implementation?

• Visualization results

Triple P in the Netherlands 2004 - 2015

How it all began

• It all started in 2004

• A good (evidence based) program for

parenting support was needed

• Triple P looked promising

• Funding for pilot in three municipalities

Very positive results

• Collaboration within the municipality

improved

• Parents were very enthusiastic about

the program

• Behavioural problems reduced and

parental competence improved

2006 - 2015

• In 2006 Triple P came available in the Netherlands:

- Primary Care

- Group

- Standard

- Seminars

• Triple P rapidly spread

• More Triple P interventions came available

Triple P trained practitioners

Intervention (level) Number of trained practitioners

Brief Primary Care (2) 4675

Seminars (2) 191

Teen seminars (2) 20

Primary Care (3) 4359

Primary Care Teens (3) 905

Discussion Groups (3) 187

Standard (4) 1532

Standard Teens (4) 370

Group (4) 868

Group Teens (4) 326

Standard Stepping Stones (4) 278

Enhanced (5) 349

Family Transitions (5) 126

Total number 14.186 practitioners

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Available in 204 municipalities

Stadsregio Amsterdam: Amsterdam (alle stadsdelen), Zaanstreek Waterland (7 gemeenten), Amstelland (4 gemeenten) en Haarlemmermeer.Noord Brabant: ‘s-Hertogenbosch, Land van Cuyk, Schijndel, Boxtel, Vught, Uden/Veghel,St Michielsgestel, Oosterhout, Eindhoven, Breda, Heusden, Regio Eindhoven (SER, 21 gemeenten ), West Brabant (14 gemeentes), Tilburg, Waalwijk, Dongen, Oisterwijk, Gilze en Rijen, Hilvarenbeek, Loon op Zand, Goirle. Overijssel: Hardenberg, Deventer, Regio Twente: Almelo, Borne, Dinkelland, Enschede, Haaksbergen, Hellendoorn, Hengelo, Hof van Twente, Losser, Oldenzaal, Rijssen-Holten, Tubbergen, Twenterand, Wierden. Noord Holland: Gemeenten in Gooi en Vechtstreek (Bussum,Hilversum, Blaricum, Huizen,Laren,Muiden, Naarden, Weesp Wijdemeren) en Regio Zuid-Kennemerland (Haarlem, Heemstede, Bloemendaal, Zandvoort, Haarlemmerlide & Spaarnwoude)Regio Noord-Kennemerland (Alkmaar, Bergen, Heerhugowaard, Castricum, Heiloo, Langedijk, Graft-De Rijp en Schermer)Regio West-Friesland (Enkhuizen, Drechterland, Medemblik, Opmeer, Koggenland, Stede Broec, Hoorn).Kop van Noord-Holland (Texel, Den Helder, Harenkarspel, Zijpe, Schagen, Hollands Kroon).Regio Midden-Kennmerland: (Velsen, Beverwijk, Heemskerk en Uitgeest).Zuid Holland: Maassluis, Leiden, Leiderdorp, Voorschoten, Kaag Braassem, Zoeterwoude, Oegstgeest, Alphen aan den Rijn, Nieuwkoop, Rijnwoude, Den Haag (alleen JGZ) en Katwijk, Lisse, Hillegom, Teylingen, Noordwijk, Noordwijkerhout.Friesland: Smallingerland, Heerenveen, Achtkarspelen, Leeuwarden, Tytsjerksteradiel, Sudwest Fryslan, Lemsterland, Gaasterlan-Sleat, Littenseradiel, Weststellingwerf, Dongeradiel, Kollummerland, Dantumadiel, Ameland, Terschelling, OpsterlandOverige 11 gemeenten JGZ instellingen.Groningen: Groningen en HoogezandDrenthe: Aa Hunze, Borger Odoorn, Coevorden en Emmen.Gelderland: Renkum, Zaltbommel, Maasdriel, Lingewaal en Regio Noord Veluwe (Putten, Ermelo, Elburg, Oldebroek, Nunspeet, Harderwijk)Limburg: Regio Oostelijk Midden Limburg (4 gemeentes), Regio Oostelijk Zuid Limburg (9 gemeentes), Regio Zuid Limburg (5 gemeentes), regio Westelijk Midden Limburg (3 gemeentes)Zeeland: Goes (allen JGZ) , Terneuzen (CJG)BES Eilanden: Bonaire, Sint Eustatius en Saba

What is implementation?

A specified set of purposeful activities at the

practice, program, and system level designed

to put into place a program or intervention of

known dimensions with fidelity.

Ref: Dean Fixsen and Karen Blasé 2011, NIRN

What we know

70 % of the change processes of Dutch organisations prematurely

freeze or do not reach the intendedeffect (Boonstra, 2000).

Video

What is needed for successful implementation?

Effective program x non effective implementation = 1 x 0 = 0

Non effective program x effective implementation = 0 x 1 = 0

Effective program x effective implementation = 1 x 1 = 1

= Good outcomes for parents and children

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Discussion

What implementation concerns do you

have in your role as practitioner, trainer,

coordinator, manager, researcher?

Overview

• Triple P in the Netherlands

• Implementation of Triple P in Amsterdam

• What do we know about successful

implementation?

• Visualization results

Triple P in Amsterdam

Good starting position:

• Enthusiastic policymakers

• Population approach, including level 1

• Need for implementation recognized

Implementation plan

Key elements:

• Collaboration on different levels

• Phased implementation in 14 districts

• Implementation plan per organization

Collaboration on different levels

Policy makers Managers

Project lead

Intern

coördinators

Phased implementation in 14 districts

• Enthusiastic, advanced districts as a

pioneer

• Good examples and adjusted plans for

reserved districts

• Project lead: connecting experiences

instead of ‘evangelizing’

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Video

Implementation plan per organization

• Which people will be trained?

• How many interventions are expected per

person while doing their regular job?

• From training to practice � need for

support

From training to practice

• Intervision

• Extra time to practice, coaching

• Goal setting, registration, appraisal

• Additional workshops

• Practical framework (e.g. tipsheets,

registration system)

Number of interventions 2009-2014

Looking back…

• Momentum

• Forerunner

• Money can buy anything?!

Overview

• Triple P in the Netherlands

• Implementation of Triple P in Amsterdam

• What do we know about successful

implementation?

• Visualization results

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Importance of implementation

• Focus on training

• Only training is not enough

• Maintenance is hard:

- Meetings with local coordinators

- Training for supervisors

- Workshops for trained practitioners

Important questions

• What is the current situation? Are

changes needed?

• What are your goals?

• Who are you going to train? At what

level?

• How are you going to inform parents

about Triple P?

• What is the budget you need?

• How are you going to maintain you goals?

• ……

Phases of implementation

• Preparation (adoption,

engagement and implementation

planning)

• Implementation (Training and

accreditation)

• Maintenance

‘Kansrijk Implementeren’

Goal of the project:

Research into the implementationproces of

Triple P in the Netherlands

(Trimbos Institute: Ireen de Graaf)

Research ‘Kansrijk Implementeren’

1) Evaluation of the steps in the

implementation process

2) Is Triple P successful implemented in the

Netherlands?

3) Research into the program integrity

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Discussion

• What are your experiences with

the implementation of Triple P in

your country, municipality or

organisation?

• Which steps were/weren’t

followed in your country,

municipality or organisation?

• What are success factors and

what are implementation issues?

Phases of implementation

• Preparation (adoption,

engagement and implementation

planning)

• Implementation (Training and

accreditation)

• Maintenance

1) Evaluation of the steps in the implementation process

Results study 1

• Coordinators didn’t follow all of the steps of the

implementation plan

• Coordinators find ‘Create support among

practitioners’ an important step

• Coordinators have sometimes minimal/little

influence on the implementationprocess

• Coordinators focus more on training than on

the selection of the right practitioners

• Activities from the phase of maintenance were

organised too late

• Coordinators pay little attention to registration

2) Is Triple P successful implemented in the Netherlands?

Succesful implementation:

• The number of started interventions

• The number of interventions that will

be finished completely

• Program integrity

How many practitioners deliver

Triple P after training (%)?

Results study 2

• 54% of the practitioners work with Triple P

after training

• Practitioners performed fewer sessions (than

the standard)

3) Research into the program integrity

Results study 3

• Variation in the way

practitioners deliver Triple P

• Practitioners do not always

carry out the key elements

• Practitioners feel competent

about the way they deliver

Triple P

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Discussion

How can you support practitioners to deliver the program as designed?

Overview

• Triple P in the Netherlands

• Implementation of Triple P in Amsterdam

• What do we know about successful

implementation?

• Visualization results

Collecting more evidence

• Need for evidence based program

• Can we use the structure of the program

(questionnaires) to reinforce the evidence

based character and the implementation

of the program?

• Start of the ‘monitor’ for greater

Amsterdam

Monitoring in (greater) Amsterdam

• Use of the regular questionnaires in an

online environment

• Working with questionnaires is new for

many organizations

• Feels like bureaucracy

Showing results

• Annual factsheet with results for policy,

management and practitioners

• Most active organizations have enough

data for analysis on organization-level �

reinforcement!

• Practitioners discover value for the

individual intervention

Limitations

• Triple P is unique in monitoring

• Large percentage missing data make

results less reliable

• Current transition is looking for ‘efficiency’

and pressurizes the monitoring system.

• Practitioners on turn

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Discussion

• Do you work with questionnaires?

• Is data collected? On what level?

(organisation, municipality, region)

• How are the results used?

Systematically collect information

Dashboards with analysed data

• National level

• Level of municpality

- Organisation

• Level of organisation

- Team

- Practitioner

Number of interventions

Age and sex Satisfaction

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Parenting Scale – pre and post Parenting Scale - effectsize

SDQ Filters

What is implementation?

A specified set of purposeful activities at the

practice, program, and system level designed

to put into place a program or intervention of

known dimensions with fidelity.

Ref: Dean Fixsen and Karen Blasé 2011, NIRN

What is needed for successful implementation?

Effective program x non effective implementation = 1 x 0 = 0

Non effective program x effective implementation = 0 x 1 = 0

Effective program x effective implementation = 1 x 1 = 1

= Good outcomes for parents and children

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Marion van Bommel: m.vanbommel@nji.nl

Jolyn Berns: j.berns@nji.nl

Irene Sies: ISies@HETABC.NL

Ireen de Graaf: igraaf@trimbos.nl