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Parenting support within Child and Family. Evolution towards more evidence-based services


Background. Child and Family is a public agency charged with the promotion and organi zation of child care and welfare in Flanders (Belgium). One of the main fields of activity is preventive family support (medical and psycho-social).
Free preventive family support is provided from each of the 300 infant welfare clinics in Flanders. While children are at pre-school age, parents are offered the chance to attend up to ten consultations at the infant welfare clinic. During these consultations we follow-up the development of the children, give vaccinations, pay attention to possible health-risks and give parenting support. In addition, the regional nurse (600) will make one or more house visits to all families with newborn babies. During these house visits we give parents information and support regarding the care, well-being and growth process of their baby. Parents with further questions or risk indicators regarding health, development and parenting can take advantage of extra consultations and house visits. As a component of this comprehensive family support more and more emphasis is put on parenting support. Parenting support is aimed at strengthening parenting. Those services are designed to alleviate stress and promote parental competencies that will increase the ability of families to use other resources and opportunities available in the community and create supportive networks to enhance child-rearing abilities of parents (Whitelaw Downs et.al., 2000, p. 80). Services may include home visiting as well as centre-based activities. These services take an empowerment focus, working in partnership with parents. Our parenting support services attempt to prevent problems (e.g. child maltreatment, behaviour problems) but in the first place they have the intention to enhance the families' quality of life.
Child and Family is very unique because there services are universally available. They reach almost all families in Flanders.

Method. A frequently used method of parenting support is opening up a discussion about parenting. A dialogue is entered with the parent(s) about parenting. It can be based on a pre-arranged parenting topic considering the developmental stages in children. The aim is to enhance the competence of parents, to build on existing strengths. More specific methods of parenting support within the preventive care of Child and Family are:

  • Parenting consultations. It is an easily accessible, short-term support for parents for minor parenting problems or parenting stress. These parenting consultations last max 4 to 5 times and are offered by a nurse. The nurses are supervised by parenting consultants.
  • Parenting group work aimed at information transfer (topical meetings) or sharing experience and concerns with other parents.
  • Practical parenting support or doing things together. Practical parenting support means cooperating, giving demonstrations and/or talking about subjects to do with caring for and bringing up children, with a view to reinforcing parenting skills and promoting positive parent-child interaction.

As parenting support have become part of core business of our organisation, we more and more choose for the implementation of evidence based, well-researched methods of parenting support. This was also the expectation of our policy-makers. As an example, we started in the City of Antwerp with the implementation of Triple P (Positive Parenting Program), a multi-level, preventively-oriented parenting support strategy developed by Matt Sanders at The University of Queensland in Brisbane, Australia (Turner & Sanders, 2006). The system draws on social learning models that incorporate many successful behaviour change techniques for influencing the parent-child interactions. Interventions incorporate:

  • a universal population-level media information campaign targeting all parents (level 1);
  • primary care consultations targeting mild parenting problems (level 2 and 3);
  • intensive parent training (level 4 and 5).

We especially are interested in implementing level 1, 2 and 3. Triple P is very compatible with the organisation-features of Child and Family:

  • it focuses on professionals serving the public, also in settings other than mental health and welfare services;
  • it is available at population-level and not only for certain groups;
  • the focus on prevention is defined as a focus on health promotion.

It is also a unique program because (Turner & Sanders, 2006):

  • it is evidence-based, well-researched in an international context;
  • it has good resources (e.g. clinician manuals, client materials) that are professional¬ly produced and provide user-friendly trainings to all types of professionals provision of detailed procedural guidelines;
  • the program is standardized and culturally sensitive.

In this paper we want tot stress the evidence-based character of the program. Triple P began with the first findings published in the early 1980s. Since that time the intervention methods used in Triple P have been subjected to a series of controlled evaluations. This research shows that "when parents change problematic parenting practices, children experience fewer problems, are more cooperative, get on better with other children and are better behaved at school. Parents have greater confidence in their parenting ability, have more positive attitudes toward their children, are less reliant on potentially abusive parenting practices and are less depressed and stressed by their parenting role" (Sanders, Markie-Dadds and Turner, 2003, p. 19). Research on Triple P has also been conducted in the VS, Germany, UK, Switzerland and the Netherlands .
Triple P was also mentioned by the World Health Organisation (2004) as one of the effective strategies to prevent mental disorders with children.
As we just started to implement the program in the city of Antwerp we see some serious barriers in our organisation related to the implementation of Triple P, such as misinformation and resistance to the introduction of the new program, difficulty in the integration of the program with usual caseload, supervision-structure etc. We conclude that effective dissemination involves more than program implementation at an individual level (Turner & Sanders, 2006):

  • alliances must be created with key stakeholders and leaders of the organisation. It is important to inform them about the potential benefits, the logistics involved, the costs of adaptation and the benefits of providing continuing support;
  • Sanders stresses the importance of ongoing supervision in the implementation of the program. In the dissemination of Triple P, establishment of peer support networks and a self-regulatory approach to supervision is promoted. Therefore we need an environment that support and encourage them to do so also in the longer term;
  • Triple P has not to be implemented in isolation. It must be also a topic of interagency collaboration where other partners learn to know the program. Triple P can facilitate communication and networking between agencies. Networks of pro¬fessio¬nals can then provide a forum for communication of innovations and new findings and promote a culture of evaluation.

Central to this process is the identification of a program-coordinator who can be engaged in the interpersonal contact with dissemination staff and internal and external stake-holders.

Key references
Sanders, M.R., Markie-Dadds, C., & Turner, K.M.T. (2003). Theoretical, scientific and clinical foundations of the Triple P - Positive Parenting Program: A population approach to the promotion of parenting competence. Parenting Research and Practice Monograph, 1, 1-21.
Turner, K. & Sanders, M. (2006). Dissemination of evidence-based parenting and family support strategies: Learning from the Triple P-Positive Parenting Program system approach. Aggression and Violent Behavior, 11, 176-193.
Whitelaw Downs, S. et al. (2000). Child Welfare and Family Services. Policies and Practice. Boston: Allyn and Bacon.
World Health Organization (2004). Prevention of Mental Disorders. Effective interventions and policy options.

Contacts: Benedikte Van den Bruel, Stafmedewerker pedagogische preventie, Kind en Gezin Hallepoortlaan 27, B-1060 Brussel, Benedikte.VandenBruel@kindengezin.be, Phone 0032 2 533 14 59.

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