Triple P - Positive Parenting Program: AZ Expands Triple P to - - PowerPoint PPT Presentation

Triple P - Positive Parenting Program: AZ Expands Triple P to Address the Opioid Crisis

Cricket Mitchell, PhD Lead Triple P Coordinator & Evaluator, PCA Arizona Carol Lopinski, MSW Triple P Coordinator, PCA Arizona Randy Ahn, PhD, MLIS Implementation Consultant, Triple P America

Acknowledgements

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 Prevent Child Abuse Arizona would like to thank  Our current Triple P funders:  Our prior Triple P funder:

Today’s Session

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 Overview of Triple P  Bringing Triple P to Arizona  Impact of PCA AZ Triple P Funding To-Date  The Opioid Crisis, Parenting, and Triple P  Triple P as Part of the Governor’s Office of Youth,

Faith and Family’s Prevention Strategy for Opioid Use Disorders

 Questions and Discussion

What is Triple P?

Blueprints Certified

Meeting the highest standards of evidence through independent review by the nation’s top scientists

Triple P - Positive Parenting Program An evidence-based population approach for improving parenting practices and children’s social and emotional well-being. For families with children 0-16 yrs

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Translating Research into Practical Interventions

Holder of Intellectual Property Professor Matt Sanders Primary Researcher/Developer University Technology Transfer Company Triple P Global Offices Licensed Content Global Research Community Triple P Providers Practitioners 501c3 Organizations Public Agencies Others Training Technical Assistance & Resources Triple P International Consultant

Triple P’s Evidence Base

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What is Triple P?

An evidence-based population approach for improving parenting practices and children’s social and emotional well-being.

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Intensive family intervention Broad parent training Narrow parent training Brief consults/Seminars Media strategy

Intervention Intensity Population Reach

Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information.

Improves parent anger management, coping with stress, co- parenting; reduces child obesity, behavior problems Improves parent-child relationships, encourages and teaches positive behaviors, manages misbehavior Improves ways of handling common behavior problems and developmental challenges Brief consults for discrete problems, seminars for raising resilient kids and conveying positive parenting strategies Outreach and media strategy for de-stigmatizing parent education and facilitating referrals

4-14 8-10 1-4 1-3

Encounters

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What is Triple P?

An evidence-based population approach for improving parenting practices and children’s social and emotional well-being.

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Intensive family intervention Broad parent training Narrow parent training Brief consults/Seminars Media strategy

Intervention Intensity Population Reach

Improves parent anger management, coping with stress, co- parenting; reduces child obesity, behavior problems Improves parent-child relationships, encourages and teaches positive behaviors, manages misbehavior Improves ways of handling common behavior problems and developmental challenges Brief consults for discrete problems, seminars for raising resilient kids and conveying positive parenting strategies Outreach and media strategy for de-stigmatizing parent education and facilitating referrals

4-14 8-10 1-4 1-3

Encounters

Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information.

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What is Triple P?

An evidence-based population approach for improving parenting practices and children’s social and emotional well-being.

Principles of Positive Parenting

Safe & engaging environment Positive learning environment

Assertive discipline Realistic expectations Taking care of yourself

Practitioners Parents Observe Analyze Practice Plan ahead Self reflect Adjust Model Instruct Role play Discuss Collaborate Facilitate

Positive Parenting Strategies

Cognitive-behavioral content Insight-oriented process

Self- Regulation

Neurodevelopmental functioning

10 Triple P Strategies

Manage Challenging Behaviors Teach New Skills & Behaviors Encourage Positive Behaviors Develop Positive Relationships

Re-organization of parenting time and effort from overly harsh or lax practices to ones that build attachment and positive parent-child relationships. Re-setting the set point for family hostility and conflict Re-orienting parents to the power of love Brief quality time, talking to children, affection Praise, positive attention, engaging activities Modelling, incidental teaching, ask-say-do, behavior charts Ground rules, directed discussion, planned ignoring, clear, calm instructions, logical consequences, quiet time, time-out

TEMPERAMENT X ATTACHMENT STYLE X POSITIVE PARENTING = CHILD SELF-REGULATION

Learning to Self-Regulate

I want the whole world

Veruca Salt

Blaming the kids is a lie and a shame. You know exactly who's to blame: The mother and the father!

Oompa Loompas

A self-regulating individual:

– Guides their own behavior – Copes with powerful emotions – Demonstrates self-control – Manages their thoughts and beliefs – Focuses attention, problem solves, and organizes their resources

How would these abilities make an individual a better parent and how do we do this without blaming and shaming?

Learning to self-Regulate

I want the whole world

Veruca Salt

Blaming the kids is a lie and a shame. You know exactly who's to blame: The mother and the father!

Oompa Loompas

Are the self-regulatory skills learned in the context of being a positive parent, transferable to a parent’ s recovery from an OUD?

Parents with mental health or substance abuse problems are more likely to have impaired capacity to regulate their cognitions, emotions, and behavior.

2009 2011 2012 2013 2014 2010

Triple P Developer, Professor Matt Sanders Triple P Parenting Forum at PCH

Bringing Triple P to Arizona’s Families

Keynote Presentation PCA AZ CAP Conference

Early Adopters

Local AZ Org Runs 1st Pilot of Triple P On-Line 13

2015 2017 2018 2019 2020 2016

Bringing Triple P to Arizona’s Families

PCA AZ Triple P Community Forum and Prof Sanders’ Master Class for AZ Practitioners Triple P Capacity Building Grant to PCA AZ CYs 2015-2017 Expanding Triple P in Maricopa County Grant to PCA AZ CYs 2018-2020 Triple P as Part of the State Opioid Response Grant to PCA AZ FYs 2019, 2020 14

PCA AZ Grant-Funded Triple P Training

15 Steele Cohort 1: Level 4 Standard Steele Cohort 2: Level 4 Group Steele Cohort 3: Level 3 Primary Care (shared cohort with MCDPH) Piper Cohort 1:

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Cost-Sharing Opportunity Level 3 Primary Care Stepping Stones Extension Piper Cohort 2:

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Cost-Sharing Opportunity Level 4 Group Stepping Stones Extension Piper Cohort 3:

+

Level 4 Standard Level 5 Pathways Extension

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Maricopa County Triple P To-Date

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Calendar Years 2015-2018 1,863

Triple P Services

2,064

Parents/Caregivers Served

20 DISCUSSION

GROUPS

118 Parents 52 SEMINARS 389 Parents

Population Reach

1:1 Services

Level 2 Triple P

Small Group Format STANDARD

269 Parents

Level 3 Triple P Level 4 Triple P

458 BRIEF

CONSULTATIONS

224 Parents

GROUP

1,064 Parents

Maricopa County Triple P Outcomes

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• ut of 10 Maricopa County

parents/caregivers reported the highest quality ratings for Level 4 Standard and Level 4 Group Triple P

• ut of 10 who participated in Level

4 Standard or Level 4 Group Triple P reported that the program helped them to deal more effectively with their children’s behavior Clinically significant improvements for Maricopa County parents after participation in Level 4 Triple P:

Each circle above represents parents who reported clinically significant depression, anxiety, and/or stress prior to participating in Triple P. The green portion represents the percentage who then dropped into the non-clinical range after completing Triple P.

• ut of 10 reported that the

program helped them to deal more effectively with problems that arise in their families

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Scope of the US Opioid Crisis

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

From 1999 to 2017, more than 700,000 people have died from a drug overdose.

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Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an

• pioid.



In 2017, the number of overdose deaths involving opioids (including prescription

• pioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6

times higher than in 1999.

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130 people in the United States die each day after overdosing on opioids

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Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

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About 80 percent of people who use heroin first misused prescription opioids.

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In 2016, an estimated 11,824,000, or 4.4% of persons aged 12 and older, reported opioid misuse in the past year

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By gender, reported opioid misuse was 4.9% among males and 3.9% among females.

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By age, reported opioid misuse was highest among persons aged 18–25 (7.3%) and persons aged 26–34 (7.2%). https://www.cdc.gov/drugoverdose/epidemic/index.html

AZ Opioid Deaths

source: drugabuse.gov

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AZ Prescription Rates Decline

source: drugabuse.gov

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AZ DHS Real-Time Data

https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php

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In Arizona, the rate of NAS/NOWS increased by fivefold from 1.5 cases per 1,000 hospital births in 2008 to 7.3 cases per 1,000 hospital births in 2016 (Arizona Department of Health Services).

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The National Survey on Drug Use and Health (NSDUH) Between 2009 and 2014, nearly 3% (2.1 million) of US children age 17 years and younger lived in households with at least 1 parent struggling with a substance use disorder

Fentanyl

Child Dysregulation

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• Insecure/disorganized

attachment

• Impaired executive functions
• Motor delays
• Increased foster care placement
• Child abuse reports
• School problems, LD, ADHD, other mental health

disorders

• Increased risk for OUD in adolescence
• Probable epigenetic effects passed on to subsequent

generations

Parent Dysregulation

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• Maternal insensitivity – emotional

unavailable

• Less adaptive parenting behaviors

– inflexible and rigid

• More critical, negative, and greater

use of threats

• Depression and parenting stress present
• Lack of parent involvement
• Lack of boundaries/intrusiveness
• Difficulty with structuring and planning

Lessons from Dr Felitti

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 Adverse Childhood Experiences

are hidden by shame and lost in time

 We must move away from asking, “What’s wrong with

you?” towards, “What has happened to you?”

 Understanding symptoms and root causes

So, perhaps one pathway may be as follows: Parent-children dysregulation is a symptom of OUD which in turn, stems from mismanaged chronic pain that got out of control.

Triple P Increases Parent Self-Regulation

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 Raising children requires parents to

self-regulate their own attention, cognitions, emotions, and actions.

 This includes figuring out how to

respond to their child’s prosocial and problem behaviors. It involves deciding what to say and do (words and actions), how to convey their message (tone of voice, facial expression, body language), and how to time (e.g., immediate, delayed),

• rganize, and sequence their actions

Self-Monitoring and Adaptation

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 Self-sufficiency approach  Self-efficacy (believing in themselves)  Self-management (e.g. self-reflection and goal setting)  Personal agency (positive self-attributions)  Problem-solving

All this is done through observation, role plays, group discussion, didactic presentations, data gathering and assessment, practice in session and at home (homework) to generate a parenting plan, learn positive parenting strategies, and fine tune.

Can Triple P Decrease Chronic Pain?

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 Pain is the most common reason that people see a

physician.

 At least 100 million adults in the United States suffer

from chronic pain, according to the Institute of Medicine.

 Having a painful condition is stressful and learning to

managing your emotions can directly affect the intensity

• f your pain.

 Self-regulation approaches very similar to Triple P’s

approach to parenting have been trialed for chronic pain disorders with success.

Napa vs Sonoma CAN after 2017 Wildfires and During Opioid Crisis

Actual children abused or neglected percent change between 2016-17 Sonoma Napa Under 1 84.7 157.1 1-2 103.8 95.2 3-5 83.7 126.7 6-10 91.3 137.3 11-15 89.1 185.4 16-17 86.5 300 Total 89.3 145

Positive Parenting Families Reached:

22% 9%

Can widespread positive parenting buffer communities?

A Double Dose of Trauma

Nationally, rates of drug overdose deaths and drug-related hospitalizations have a statistical relationship with child welfare caseloads (that is, rates of child protective services reports, substantiated reports, and foster care placements). Generally, counties with higher overdose death and drug hospitalization rates have higher caseload rates. In addition, these substance use indicators correlate with rates of more complex and severe child welfare cases.

ASPE Research Brief:March 7, 2018. Substance Use, the Opioid Epidemic, and the Child Welfare System: Key Findings from a Mixed Methods Study

Triple P as Prevention for Opioid Use Disorders (OUD): Governor’s Office of Youth, Faith and Family Grant Year 1

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Evidence-Based Parenting Education and Parenting Skills Training1 as a Critical Component of the State’s Opioid Prevention Strategy

https://creativecommons.org/licenses/by-nc/3.0/

1 United Nations Office on Drugs and Crime, Guide to Implementing Family Skills Training Programmes for Drug Abuse Prevention, 2009: with

supplemental publication, Compilation of Evidence-Based Family Skills Training Programs (Vienna: United Nations 2007), available from http://www.unodc.org/documents/prevention/family-guidelines-E.pdf & http://www.unodc.org/docs/youthnet/Compilation/10-50018_Ebook.pdf.

Triple P: AZ Governor’s Office of Youth, Faith and Family Grant Year 1

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Three Identified Target Populations

Child Welfare- Involved Parents/ Caregivers Reunifying Parents who have Experienced Domestic Violence Incarcerated Parents at time

• f Re-Entry from

State Prison

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 Serving high-needs populations

Intervention Intensity Population Reach

Improves parent anger management, coping with stress, behavior problems Improves parent-child relationships, encourages and teaches positive behaviors, manages misbehavior

Improves ways of handling common behavior problems and developmental challenges Brief consults for discrete problems, seminars for raising resilient kids and conveying positive parenting strategies Outreach and media strategy for de-stigmatizing parent education and facilitating referrals

Targeted Outreach, Engagement, and Identification of Triple P Trainees to Address AZ OUD

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 Outreach: 68 organizations, public agencies and

community leaders

 Engagement: 52 organizations and public agencies

who provide direct service to one or more of the target populations

 Identification of 40 new Triple P trainees statewide

 20 (one cohort) Level 4 Standard + Level 5 Pathways  20 (one cohort) Level 4 Group + Level 5 Pathways

• Training and Accreditation will be complete by Sep 30, 2019

https://www.mapofus.org/arizona/

= new Triple P

Practitioner under Governor’s Office

• f Youth, Faith and

Family grant Y1

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Cricket Mitchell, PhD Triple P Lead Coordinator and Evaluator Independent Contractor for Prevent Child Abuse Arizona email: triplep@pcaaz.org Carol Lopinski, LCSW, ACSW Triple P Coordinator Independent Contractor for Prevent Child Abuse Arizona email: carol@pcaaz.org Randy Ahn, PhD, MLIS Implementation Consultant Triple P America email: randy@triplep.net

Questions?

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