- By Kevin Mount
- Posted on Friday 30th May, 2008
What happens when prevention science meets the real world?One way to find out is to look at the impact it has – consider how frequently proven models are successfully taken to scale. Another is to examine how far effective programs meet the needs of policy makers, who in turn are answerable to the public; but, as a round-table discussion at this weeks Society for Prevention Research conference demonstrated, getting better outcomes for children does not always make policy makers happy.Ron Prinz from the University of South Carolina brought together a panel to look at interface between effective parenting programs and the prevention of child abuse. It boasted the originators of two of the world’s most effective parenting programs, David Olds from the University of Colorado, Denver (Nurse-Family Partnership) and Matt Sanders from the University of Queensland, Australia (Triple P).As each admitted, while their prevention programs have been shown over and over to improve parenting and reduce impairments to children's health and development, there has been little impact on child protection reporting rates. That said, Prinz and Sanders recent study in South Carolina links Triple P to a reduction in the prevalence of child abuse at a population level.The problem is that child protection systems are a poor proxy for actual levels of maltreatment. Nearly a decade ago work by Adrea Theodore and Desmond Runyan indicated that rates of child abuse outstrip official records many tens of times over. On the basis of their findings, effective programs would have to reduce maltreatment by a huge margin to make any dent on the small proportion known to child protective services.Another difficulty, highlighted by David Olds, is that effective programs tend to increase the likelihood that child maltreatment will be detected. They bring trained practitioners into people's homes. They encourage the active involvement of family members. Such vigilance tends to mean official rates of child protection reporting go up while the underlying rate of poor parenting goes down.That is cold comfort to the lawmakers Dennis Embry from the PAXIS Institute engages with on a regular basis. They want a reduction in the number of serious injuries. They want to reduce the numbers in out-of-home care systems. They don't see votes in better parenting. Less maltreatment is not going to be visible in the flawed but headline figures generated by child protection reporting statistics.Sandra Azar, Professor of Psychology at Penn State University, bemoaned the lack of objective measures of child protection. “It reminds me of the juxtaposition of crime rates and conduct disorder rates,” she said. “Conduct disorder is the underlying problem, and crime rate is one manifestation. We know how to measure conduct disorder with some precision, but we do not even have an agreed construct with respect to child maltreatment”.
Lessons from “Driving Mum and Dad Mad”
Matt Sanders took the conversation in a more productive direction. He looked at the public health potential of effective parenting programs. In 2005, a six-episode television series on parenting in the UK called “Driving Mum and Dad Mad” followed five families through one of the Triple-P programs.The screening created a unique opportunity to conduct a natural experiment where an evidence-based programme was delivered through a TV medium to an estimated five million UK viewers. It was an opportunity to evaluate the impact of a media strategy in promoting positive parenting and improving child adjustment.At the most conservative estimate, Sanders said, several tens of thousand of children experiencing significant maltreatment in families would have seen the broadcasts. The combination of even modest effect sizes combined with the coverage achieved by television would be sufficient to make a significant dent in levels of abuse, reported and unreported. But what is the minimally sufficient effect required from such public health strategies that will make politicians sit up?Not that Sanders believes we should allow politicians to set the agenda. An effective communicator himself, he has done much to change public opinion towards child maltreatment, working with the media to encourage less blame and more interest in prevention.He has come to recognize that much more can be achieved by listening to what parents want and need than by dragging the reluctant into clinics. To add to the experimental data attesting to the benefits of Triple-P, Sanders has started collecting information on consumer preference. It shows that people want effective programs. But it also shows that they would rather get the information from TV than from psychologists in a clinic.What about the practitioners busy with child protection and family support? Many look at programs like Nurse Family Partnership and Triple-P and say “all very interesting but it doesn't deal with my problem”. Ironically, practitioners imagine that prevention scientists and their programs are awash with money, when the reverse is true.How then will they respond to Sanders's call for greater concentration on public health approaches delivered through many media, or for greater emphasis on peoples' capacity for self-directed change. All of this is going to require the children's services workforce to think differently. Sandra Azar commented on the need for a better understanding of the workforce, of their professional prejudices included.The round-table was a reminder of the advances in child protection and the distance still to travel. Twenty five years ago proven child maltreatment by economically disadvantaged parents generally led to the removal of children – an unproven and, in all likelihood, ineffective response. Today we know better how to prevent poor parenting and maltreatment, but not how to do this effectively for all. And we certainly don't know how to get politicians to see the benefits that parents can see in such a strategy.Reference
Theodore A D and Runyan D, “A Medical Research Agenda for Child Maltreatment: Negotiating the Next Steps”, Pediatrics
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