promoting self regulation and relational competence in ... · personality, sociability, maternal...

Transforming

Children’s Lives

Through Positive

Parenting

inMatthew R Sanders, Ph.D.

Parenting and Family Support Centre

The University of Queensland

November, 2018

Triple P Ontario Conference

• Disclosure statement• The Triple P-Positive Parenting Program is owned

by the University of Queensland. UQ licensed Triple P International Pty Ltd to disseminate the program worldwide

• Royalties are distributed to the Faculty of Health and Behavioural Sciences, School of Psychology, PFSC and contributory authors

• Professor Sanders is the founder, lead author and a consultant to Triple P International

How can

parenting

programs help

transform the

lives of children,

parents and

communities?

3

4

Good parenting is the

clean water of child mental

health and well being

5

Parenting has a pervasive impact

on development, learning and well being

Parent-child

relationship and

parenting

practices

Healthy brain development

Language,

communication, literacy

Executive functions

and self regulation

Academic attainment

Conduct problems/

antisocial behavior

Anxiety and stress

Attentional problems

Social skills and

peer relationships

Obesity

Chronic health problems

Pain management

Sedentary behavior

and physical activity

Screen time/

Online behavior

Moral development/values

6

Consistent

assertive

discipline

Taking care

of oneself

A safe and

engaging

environment

Positive

learning

environment

Reasonable

expectations

Core

Principles

Why positive parenting is so important

7

Effective

communication

with teachers/

carers

Being part of

the

community

Supporting

children’s

relationships

with peers

Balancing

work and

family

responsibilities

Maintaining

healthy

relationships

with extended

family

Other

positive

parenting

skills

Positive Parenting strategies

Children 2-12 years

Developing a positive

relationship

Encouraging desirable

behaviour

Teaching new skills and

behaviour

Promoting Self control

Brief quality time Praising children Setting a good example Establishing ground rules

Talking to your child Giving positive attention Using incidental teaching Directed discussion

Showing affection Providing engaging

activities

Using Ask, Say, Do Planned ignoring

Using Behaviour charts Clear, calm instructions

Logical consequences

Quiet time

Time out

9

Parenting programs provide a context to influence

other determinants of parental capability

Cognitive factorsExpectations, beliefs,

attributions, knowledge

Relationship factorsSupport, conflict, violence

Economic factorsFinancial resources,

poverty, unemployment

Parental mental healthDepression, anxiety, substance abuse

Adverse life experiencesACE’s, trauma

Self regulationExec functions

Self management

Attention, impulse control

Cultural factorsReligion, cultural values,

mores, traditions, taboos

Characteristics of childrenTemperament, preterm, disability,

exposure to trauma

Biological

genetic influencesPersonality, sociability,

maternal health

Interactional

processesReciprocity, attachment

Parent

behavior

10

Broader ecological context influences parents priorities

Parental

Engagement

- Discrimination

- Refugee status

- Type of Neighborhood

- Prior help seeking

- Level of violence

- Family of origin experiences

- Immigration status

- Culturally normative parenting

practices

- Education /literacy

- Laws

- Connectedness to community

- Parenting services

- Gender/age of parent

- Social infrastructure

- Employment status

- Poverty

- Government policies and

priorities

- Acculturation

- Parental mental health

Enablers & Barriers

Parental concerns -

Program itself -

Social context -

Cognitions or Affect

Expectations -

Motivation “Pull demand” -

11

Child, parent and family problems and vulnerability

Parental

engagement

What child?• Developmental level

• Genetic vulnerability

• Prematurity

• Low birth weight

• Developmental

disability

• Type and severity

of behavior or

emotional problem

What parent?• Depression/anxiety

• High stress

• Couple discord

• Abusive parent

• Substance abusing

• Minority parents

• Indigenous parents

• Grandparent

• Foster parent

What Family?• Violent

• Separated/divorced

• Incarcerated

• Step/blended family

• Adoptive parent

• Single parent

• Teen parent

X X

12

Population

approach

needed

Multi-level system

Multidisciplinary

Inclusive

Effective

Making it workCulturally appropriate

Different outcomes

13

A multi-level system needed “Avoid one size fits all”

Intensive family intervention

Broad focused parenting support

Level 5 Individual, Group

Breadth of reachIn

ten

sity

of in

terv

en

tion

Narrow focus parenting support

Brief parenting advice

Communication strategy

Level 4 Individual, group, self help, online

Level 3 Individual, group, online

Level 2 Individual, group

Level 1 Universal level

Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Tailoring the Triple P experience

17

• 164 RCT’s

• 96% show positive

effects

• 4% (13/321) report

null findings

• 52% have no

developer

involvement

But does it work?

International

dissemination begins

Program gets a

name

Publication of first

population trial

Building a foundation of evidence

N = 3 N = 2 N = 24 N = 2

How effective is Triple P?

N=16,009 families

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Level 1 Level 2 Level 3 Level 4 Level 5

Parenting practices

overall d=.58

Child outcomes

overall d=.47

Me

diu

mS

ma

ll

Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34(4), 337-357.

Larg

e

Comprehensive evaluation requires different types of

evidence

Service-based evaluations (e.g. Santa

Cruz, 2015)

Consumer preference studies

(Metzler et al, 2013)

Training, implementation and

supervision studies (Hodge et al,

2016)

Program evaluations in diverse

cultures (Sumagi et al, 2015)

Qualitative studies (Frank et al, 2015)

• Conceptual papers (Sanders & Kirby,

1994)

• Single-case experiments (Sanders &

Glynn, 1981)

• RCTs (Sanders et al, 2000)

• Place based RCT’s (Prinz et al, 2009,

2016)

• Quasi-experimental studies (Zubrick et

al,1995, Fives et al, 2015; Doyle et al, 2018)

• Evaluations in LMIC (Mejia et al, 2014)

• Multiple meta analyses (Sanders et al,

2014; Nowak & Heinrichs, 2008)

20

Positive parenting programs work with many

different types of children/ target problems

Different types

of children/

problem

behavior

Severe feeding

problems

ADHD

Recurrent

abdominal pain

Anxiety disorders

Gifted and talented

children

Conduct problem

adolescents

Children in natural

disasters

Children victimised

by peers

Children with ASD or

IDD

Children at risk

of abuse

Children with

trauma histories

Children with chronic

health conditions

Conduct problems

Sleep problems

Habit disorders

Mealtime problems

21

Successful population-level interventions blend

universal and targeted programs

22

Three strategies to transform lives

1. Promote self regulation

2. Enhance relationship

capability

3. Activate community

support

Key themes

What is self regulation?

Self regulation defined by Karoly (1993) as:...those processes, internal and or transactional, that enable an individual to guide his/her goal directed activities over time and across changing circumstances (contexts). Regulation implies modulation of thought, affect, behavior or attention via deliberate or automated use of specific mechanisms and supportive metaskills.

24

Self-

management

tools

Self-efficacyPersonal

agencySelf-sufficiency

Self-regulation of behavior

Minimally sufficient intervention Red

uced

need

fo

r su

pp

ort

Promote Parental Self-regulation

25

Self regulation underpins ability to parent children well

• Has a clear sense of purpose

• Knows what behaviors, skills and

values to promote as a parent

• Has realistic expectations

• Self-monitors automatically, rather

than consciously or deliberately

• When personal standards/values are

violated she brings current behavior

under personal control

• Tunes into her own actions and

searches for explanations

• Uses her knowledge to develop plans

• Carries out plan and revises as needed

• Expects to be successful and bring

about good outcomes

• Is reflective, capable of identifying

strengths and weaknesses, without

being unhelpfully self critical

• Reflections increase her self efficacy

and personal agency

• Mostly enjoys the process

26

Stress disrupts parents capacity to self regulate?

Brief increases

in heart rate

Mild elevations in

stress hormonesPositive

Serious, temporary

stress response

Buffered by

supportive

relationshipsTolerable

Prolonged

activation of stress

response systems

In the absence of

protective

relationshipsToxic

• Brain development,

structure, and function

• Behavior

• Immune function

• Gene expression

27

Reduce Adverse Childhood Experiences

(ACEs) to enhance Life Course Outcomes

Types of ACE’s

ABUSE• Physical

• Emotional

• Sexual

NEGLECT• Physical

• Emotional

HOUSEHOLD DYSFUNCTION• Mental Illness

• Incarcerated relative

• Mother treated violently

• Substance abuse

• Divorce

• 12.2 times as likely to attempt suicide

• 10.3 times as likely to use injection

drugs

• 7.4 times as likely to be an alcoholic

• 2.4 times as likely to have a stroke

• 2.2 times as likely to have ischemic

heart disease

• 1.9 times as likely to have cancer

• 1.6 times as likely to have diabetes

A person with

any 4 or more

is….

28

Benefits of Positive Parenting for Parents

• Increased self efficacy

• More positive interactions (calmer homes)

• Better relationships with children

• Less conflict with their children (harsh, coercive discipline)

• Less conflict with partners

• Better functioning at work (work-home conflict)

• Less depression

• Less stress

Parenting

skills

SR and

Life skills

• Promoting a positive

relationship

• Encouraging desirable

behavior

• Teaching new skills and

behavior

• Teaching children self control

• Self management skills

• Emotion regulation skills

• Attribution retraining

• Teamwork/ Partner support

• Self care

• Healthy lifestyles

Better

parental

self

regulation

30

Three strategies to transform lives through positive parenting

Promote self regulation

Enhance relationship

capability

Activate community support

for parenting

Key themes

31

Enhancing

relationship skills

of parents and

children

Parents

Parent/sSanders & Mazzucchelli (2018)

GrandparentsKirby & Sanders (2014)

SiblingsPickering & Sanders (in press)

PeersHealy & Sanders (2014)

Teachers/ECE/Carers

Children

Transforming the lives of children and parents

32

Poor

relationships

adversely affect

children’s well

being

Lack of

modeling and

reinforcement of

prosocial

behavior

Poor social skills

Poor conflict

management

Poor emotion

regulation

Increased risk of

social, emotional

and behaviour

problems

Grand parents and

kinship carers

Parent/s

Children’s teachers/carers/

coaches

Peers/Siblings

33

Enhancing children’s relationships to reduce bullying

Parenting influences

children’s peer relationships,

social skills, emotional

regulation and sibling

relationships.

School bullying

has severe

consequences

Depression

Lower

self-esteem

Anxiety

Loss of

friendships

Suicide

Behaviour

problems

Health

problems

School

absenteeism

Increased long-term risk

of severe mental health problems,

school dropout, involvement in

criminal justice system

35

Specific child and parent skills targeted

Child social and emotional skills

• Play skills (joining, sharing, turn taking)

• Everyday body language

• Responding calmly and

assertively to provocation

(verbal and non-verbal skills)

- Resolving conflicts

• Interpreting peer situations

• Self-regulatory skills

Facilitative Parenting skills

• Being warm and responsive

• Enabling appropriate independence

• Supporting children’s friendships

• Coaching and enabling children’s

problem solving

• Resolving conflicts effectively in

the family

• Maintaining good communication

with the school

36

Summary of findings

• At 9 month follow up compared to active controls, intervention children

experienced

(mostly medium effect sizes)

- Less bullying (child, parent, teacher report)

- Less depression

- Less aggression

- Improved social skills

- Greater liking of school

- Greater liking of same and opposite sex peers

- Less distress from peer behavior

• High levels of program satisfaction from both parents and children

37

Strategies to transform lives

Promote parental self

regulation

Activate community support

Key

strategiesEnhance relationship

capability

38

Harsh, Coercive

Parenting

Parental Self

Efficacy

Positive

Parenting

Parental

TeamworkFamily Conflict

Parent

Wellbeing

Leads to Better

Child Outcomes

Implementation of

multi-level system of

parenting support

Community

Social Capital

Social Cohesion

and Trust

Social Support

for Parenting

Collective

Efficacy

Creates positive

changes in

parenting and family

relationships

Activates community

processes that

support parenting

39

Better Child

Outcomes

Reduced child

maltreatment

Better mental

health

Improved school

outcomes

• Fewer cases of child abuse and neglect

• Lower rates of child abuse related

hospitalizations and injuries

• Fewer out of home placements

• Lower rates of serious behavioral and

emotional problems

• Reduced risk for antisocial behavior,

substance abuse, serious mental

health problems

• Improved academic attainments

(literacy-numeracy)

• Fewer conduct problems at school

• Lower rates of truancy

40





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Parenting and Intergenerational disadvantage:A population trial of the Triple P system of parenting and family support

Chief Investigators

Professor Matthew Sanders

Professor Michele Haynes

Professor Stephen Zubrick

Professor JaneenBaxter

Professor Mark Western

Associate Investigators

Dr Kylie Burke

Mr Francis Mitrou

Professor Ron Prinz

Assoc Prof Alina Morawska

Dr Bernie Baffour

Dr Orla Doyle

42





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Communication

strategy

Destigmatize Validate

EmpowerNormalize

“Stay Positive”

Engaging the media

45





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Level 2: Triple P

Seminar Series

Seminar 1

Power of Positive

parenting Seminar 2

Raising confident,

competent children

Seminar 3Raising resilient

children

90 minuteLarge group seminars

48





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Parent Discussion Groups

(Single session low intensity group

interventions)

50





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

51





Breadth of reachIn

ten

sity

of in

terv

en

tion








Medium

and high

intensity

Low

intensity or

“light touch”

Very low

intensity

Life skills Triple P

Combining parenting and life skills training

Parenting

skills

Self

Regulation

and Life

skills

• Promoting a positive

relationship

• Encouraging desirable

behavior

• Teaching new skills and

behavior

• Teaching children self control

• Self management skills

• Emotion regulation skills

• Attribution retraining

• Teamwork/ Partner support

• Self care

• Healthy lifestyles

Life Skills

Triple P

The single most important thing we can

do to improve the well being and life

opportunities of children is to increase

the knowledge, skills and confidence of

all parents in the task of raising their

children

54

Future of evidence-based parenting support

• Ongoing innovation

(e.g. environment, radicalisation, home-school communication, parenting and sport, animal

welfare, intergenerational relationships, global violence reduction)

• Understanding non-responding and mechanisms of change

• More research on dissemination and implementation (e.g. AI-

assisted online professional training, supervision)

• Keep improving positive parenting techniques (e.g. Salmon et al, 2013).

Key features of a

“family friendly”

community

What’s newNew Programs to be

Disseminated

Revised Every Parent Survival Guide Video-

all levels

Resilience Triple P (Level 5)

Lifestyle Triple P seminar series(level 2)

Fear Less Triple P (Level 4)

Positive Early Childhood Education Program

(PECE)

Baby Triple P (Level 4)

Some Programs in Development

Building Bridges Triple P (Level 3)

Life skills Triple P (Level 5)

Alliance of Parents and Teachers (APT)

New Books

Sanders, MR & Mazzucchelli, T.G. (Eds).The

Power of Positive Parenting: Transforming

the live of children, parents and

communities. Oxford.

Sanders, M, & Morawska, A. (Eds).Handbook

of Parenting and Child Development

Across the Lifespan. Springer.

57

Population level

change is an

achievable goal

Participation becomes

socially normative

Positive parenting

becomes a policy priority

and is funded accordingly Parenting

support is an

essential to the

prevention of

child problems

Key Take Outs

58

KEY QUESTION REVISITED

Can we really

transform

children's lives

in a meaningful

way?

Happier, healthier, better

adjusted children,

parents and communities

Yes we

can…

Thank you

for your attentionfor more information pfsc.uq.edu.au (R & D)

triplep.net (training, dissemination,

implementation support)

tprn.net (research network)

Twitter @drmattsanders

promoting self regulation and relational competence in ... · personality, sociability, maternal...

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