Summary of the impact

Approximately 15% of children show significant behavioural difficulties. Research at the University of Manchester (UoM) established that delivery of evidence-based parenting information via broadcast TV changed viewers' parenting behaviour and, in turn, reduced child behavioural problems. This novel delivery method was implemented and internationally disseminated via the Triple P-Positive Parenting Program. These new Triple P materials have reached an estimated 7 million families in 25 countries. This effective delivery method has also informed UK government policy and initiatives by the United Nations Office on Drugs and Crime (UNODC).

Underpinning research

See section 3 for references 1 and 2. UoM researchers are given in bold.

Key researchers:

• Rachel Calam (Senior Lecturer, 1994-2006; Reader, 2006-2011; Professor, 2011-date)
• Matthew R Sanders (Professor 20%, 2006-date; founder, Triple P-Positive Parenting Program)

Context and background
The Parenting and Family Research Group at UoM investigates the most effective ways of enhancing the skills and confidence of parents in order to improve parenting and prevent behavioural and emotional problems in children. In 2006, Sanders was appointed to UoM (20%) to formalise a collaboration with Calam (established in 2001) and, specifically, to develop `Triple P' approaches in the UK and increase their international impact. Calam and Sanders have developed new ways of delivering Triple P more widely, with a focus on reaching parents who may not benefit from standard parenting interventions offered in clinic settings. The Group's research has directly influenced policy development by local and national government and the United Nations through its Office on Drugs and Crime (UNODC) — see Section 4.

Media-based research programme: The Great Parenting Experiments
The underpinning research for this impact tested whether it was possible to improve parenting in large numbers of families through a novel, media-based delivery approach.

ITV commissioned Sanders to develop a primetime series based on evidence-based parenting research. Driving Mum and Dad Mad (DMDM) presented the intensive group-based Triple P programme in a popular format. The Home Office funded the UoM Research Group to complete a trial, `The Great Parenting Experiment' (GPE), in order to test the efficacy of this mass media delivery form in changing viewers' parenting practices. The Home Office subsequently funded a second study on a second series of DMDM (GPE2). The two resulting research papers were published in 2008 (1, 2).

The research established that it is possible to improve parenting practices and reduce child behavioural difficulties through viewing a demonstration of an evidence-based parenting programme in a mass media format.

In addition, enhancement using supplementary self-directed and web-based materials produced significantly stronger improvement effects (1). The research demonstrated significant reductions in parenting practices associated with child maltreatment. Parents at the highest risk of maltreatment were most likely to remain engaged with the research study (2), an effect not usually observed in clinic-based delivery of parenting programmes. The majority of families participating in the GPE studies reported significant behaviour difficulties with their children at baseline reflected by behaviour inventory scores above clinic cut-off; 83% had not sought prior professional help. The research demonstrated significant improvements in parenting and child behaviour following the mass media delivery of the programme, with a large effect size (d=.80) from pre-intervention to follow-up.

In summary, the research challenged orthodox opinions on effective delivery mechanisms and established that well-crafted exemplars presented via the media are sufficiently powerful to facilitate significant change in parenting and child behaviour problems. This contributed to a new approach to effective delivery of parenting interventions via public health models to reduce child maltreatment and social and emotional problems in children (see Section 4).

References to the research

The research for the Great Parenting Experiments (GPE & GPE2) was funded by grants from the UK Government Home Office and Respect Task Force. The two resultant publications were:

Details of the impact

See section 5 for corroborating sources S1-S10.

Background
Approximately 15% of children show significant behavioural difficulties. Triple P, an evidence-based positive parenting approach, has been shown to be effective in reducing these behavioural difficulties. However, parenting interventions typically rely upon face-to-face individual or group-based delivery in clinic, educational and community settings, which do not reach all those who could benefit. In particular, delivery often fails to reach: a) families with the most demanding problems who do not engage with conventional service settings; and b) large populations in countries where health and social care systems are not widely equipped to deliver face-to-face interventions. Achieving large-scale population reach of these interventions would have a major public health impact on immediate behavioural and emotional outcomes for children as well as reducing risk of maltreatment. The UNODC has recognised that longer-term beneficial effects, in relation to mental health, drug and alcohol misuse and crime, would also result from these interventions.

Reach and significance of the impact

Impact on Triple P International (TPI) delivery strategy
The proof of quantifiable benefit from this form of universal delivery (see Section 2) made a definitive case for media-based approaches in population rollout without the direct intervention of a therapist. It provided TPI with evidence for media-based strategies for population-level delivery and Triple P Online.

The TPI website cites the work as a key research finding (S1). Footage has been incorporated into Triple P materials to strengthen delivery of parenting interventions for the public. It demonstrates added value, as the materials can convey key messages without the need for person-to-person facilitation and reach many more families than could be accessed face-to-face. Since our research, every large scale population rollout of the Triple P system has included a sophisticated media and communication strategy as part of the intervention, including service implementations in the UK (Glasgow), Ireland (Longforth and Westmeath), Belgium (Antwerp), The Netherlands (Amsterdam), Canada (Alberta and Manitoba), Australia (New South Wales and Queensland), and some US states.

Following our proof of effectiveness, DMDM footage has been incorporated into DVD material for Triple P groups for families and training programmes for professionals, with 47580 practitioners trained between 2008 and 2012 (S2), as well as the recently developed Triple P Online. Both of these are now internationally disseminated parenting programmes. TPI estimate 7 million families have had exposure worldwide across 25 countries.

The Managing Director of TPI Pty Ltd, which has an exclusive licence to disseminate the Triple P-Positive Parenting Program, underlines the importance of the research into media-based delivery for TPI's operations: `The research conducted by you [the UoM group] has provided evidence for the effectiveness of a media-based modality to both reach and promote change in groups of parents who have not already engaged with parenting programmes but who could benefit. Its principles have provided important evidence for the development of Triple P Online, which has potential benefits for people with specific needs, limited access to services or multiple commitments limiting conventional access to help' (S3). For example, the online and media components of the city-wide rollout of Triple P by NHS Greater Glasgow and Clyde is based on the foundational work of the Great Parenting Experiments (S4).

Impact on policymaking in the UK and internationally
a) UK
The research was presented to the Prime Minister, Chancellor of the Exchequer and Home Secretary pre-publication in 2006. The Respect Task Force on antisocial behaviour (2006-2010) incorporated this research into Government policy, stating that parenting support should be provided alongside approaches such as antisocial behaviour orders (S5). The Director of the Troubled Families Team and the Department for Communities and Local Government confirms that: `The results [of GPE and GPE2] helped inform the rollout of parenting interventions across the UK from 2006' (S6). Triple P is one of two programmes awarded the top 4* rating by the Department for Education (S7).

b) International Reach
The task of reaching parents in low and middle income countries is developing globally. The UNODC identified family skills programmes as a first step in drug and alcohol misuse prevention programmes (S8). Media-based materials have the scope to reach communities that would not otherwise be able to access information and support. Calam has been invited to UNODC in Vienna five times in the last three years: 1) as a technical consultant to the group drafting international guidelines on family skills training; 2) as keynote speaker to its group of international drug prevention leads; and 3) as keynote and facilitator for the Paris Pact initiative to reduce opiate use and trade in Afghanistan. The Director of the Drug Prevention and Health Branch underlines the importance of the work on DMDM: `[Calam's] role has been to explain the capacity of parenting interventions to deliver change. For each keynote, footage from the ITV series "Driving Mum and Dad Mad" (DMDM) has been specifically requested, as a highly accessible example of transformation that can be achieved through media delivery of an evidence-based parenting intervention' (S8). The Panamanian government has collaborated with UNODC to test the feasibility and acceptability of Triple P discussion groups, incorporating video footage (S9). Findings indicate strong effect sizes; similar implementation is now under way in Costa Rica, and planned in other Latin American countries. The appeal of this media-based approach is the provision of video materials which can deliver a successful intervention where access to specifically trained practitioners is limited. Triple P is now listed as having the strongest evidence base in UNODC's compilation of evidence for parenting programmes for policymakers and non-governmental organisations worldwide. The compilation makes specific reference to mass media strategies (S10, p. 6).

Sources to corroborate the impact

S1.The Triple P International (TPI) website includes the DMDM studies among its key research findings:http://www.triplep.net/glo-en/the-triple-p-system-at-work/evidence-based/key-research-findings/

S2. Email from Triple P International Pty Ltd, Australia, providing a record of the number of training places January 2008-June 2012.

S3.Corroborating letter from Managing Director, Triple P International Pty Ltd, Australia.

S4.Greater Glasgow and Clyde: http://glasgow.triplep-staypositive.net/

S5. The Guardian, 26 July 2006. `No more misbehaving'. Online version:
http://www.theguardian.com/society/2006/jul/26/guardiansocietysupplement.politics
Casey discusses parenting and TV parenting programmes and the commissioning of GPE.

S6. Corroborating letter from Director, Troubled Families programme, Department for Communities and Local Government.

S7.Department for Education Commissioning Toolkit for parenting programmes http://www.education.gov.uk/commissioning-toolkit/Programme/CommissionersSearch?Classification=Universal

S8.Corroborating letter from Director, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime.

S9.Implementation of a Triple P discussion Group is demonstrated in a short video documentary made in 2012-3 in a very low income neighbourhood of Panama characterised by very high levels of drugs, violence and crime.
http://www.youtube.com/watch?v=o1VA3RJaZM0&feature=youtu.b

S10.UNODC. Guide to implementing family skills training programmes for drug abuse prevention. New York: United Nations, 2009: https://www.unodc.org/documents/prevention/family-guidelines-E.pdf
UNODC. Compilation of Evidence-Based Family Skills Training Programmes, pp. 5-12. Includes a description of universal delivery incorporating media approaches:
http://www.unodc.org/documents/prevention/family-compilation.pdf