• By Kevin Mount
  • Posted on Wednesday 04th February, 2009

Triple P evidence supports radical rethink on child protection

Most countries have systems for detecting and dealing with concerns about child abuse. Anyone worried that a child may be being harmed can alert a social worker who will judge the best response. It can be anything from deciding that no action is needed to invoking legal powers to remove a child to safer care.It sounds sensible enough. But the benefits will always be limited. There is more child abuse in any community than most people recognize, and many cases of neglectful and even violent parenting go unreported.The upshot is that maltreatment continues to be dealt with in the main retrospectively by child protection services, often when families are at crisis point. Opportunities to prevent child abuse or to intervene early are lost.In the UK, the argument for the preventive benefits of family and parenting support began to be put strongly in the early-1990s following an extensive examination of the prevalence and incidence of child abuse sexual, emotional and physical. That research found much to support the case for broad strategies to meet the needs of the whole population. Where parenting was inadequate or ordinary needs were generally neglected, abusive relationships were more likely to erupt.For two decades, every isolated child death and practice misadventure has tested the nerve and confidence of policy makers otherwise convinced by the parent support argument. Up to now, hard evidence that such approaches can be effective, affordable and successfully delivered to the general population has been in short supply.Hence the significance of work just published by Ronald Prinz and colleagues at the University of South Carolina. Previous studies have shown reductions in children?s social, emotional and behavioral problems. Theirs has been the first large-scale experimental trial to show that providing all families, not just those in crisis, with access to parenting information and support, reduces rates of child maltreatment across entire communities. Prinz and his team based their study on Triple P Positive Parenting Program developed over a period of 25 years by Matthew Sanders and colleagues at the University of Queensland, Australia. [See: Accentuating the positives with a Triple PTriple P is in the process of being piloted in the UK, and Sanders is in Birmingham this week to advise and encourage staff who are translating the program to the realities of everyday life in Britains second city.Funded by the Centers for Disease Control and Prevention the work in South Carolina was on a similarly big scale, targeting all 85,000 families with children under eight living in nine counties, and at the same running a randomized controlled trial involving nine more. To achieve this degree of coverage, they trained just under 700 people in one or more aspects of the program. These were existing staff in schools, health centers, social services, preschools and other settings where people were in direct contact with parents. As well as providing structured individual and group-based help, much effort went into media and communication campaigns. By the end of the first two years, 26,000 newsletters had been sent to parents, 185 press releases had been issued and 37 public service radio announcements had been made.

The first in a long line of population studies?

Researchers found that just under one in five (17%) families had heard of Triple P by the end of the trial. Estimates from service providers suggested that one in ten families had received some level of Triple P help. To establish the level of benefit, the team monitored three aspects of the hard end of the system substantiated cases of child maltreatment, receipt into out-of-home care and visits to emergency rooms. On all three measures, the Triple P counties did significantly better than those in the control group. The research team suggest that the impact was equivalent to reducing cases of substantiated child maltreatment by 688 and reducing out of home placements by 240 in a population of 100,000.Preliminary estimates from Prinz and colleagues put the annual cost of the communication strategy at approximately $1 per child in the population, which at first glance seems expensive. However, they argue that the costs of running parenting programs population-wide would be recovered by the reductions in abuse and neglect and the smaller need for expensive intrusive interventions such as out-of-home care.The researchers say: This trial should be viewed as the beginning of a line of population research in the prevention of child maltreatment, from which we can expect to learn much over the next several years enough, they imply, to give policy makers the confidence to think differently about child protection.[For more information on the Triple P Positive Parenting Program, visit Triple P; for more about the South Carolina study, see Population-Based Prevention of Child Maltreatment: The US Triple P System Population Trial]

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