A public health perspective to the delivery of parenting programs has the potential to greatly increase the impact of evidence-based psychological interventions targeting parents and families. However, a population-level benefit is unlikely to be achieved unless sustained programmatic efforts are undertaken to further increase the reach of efficacious interventions. In addition, such programs need to be adapted to local circumstances, be delivered in a culturally relevant manner, and be used in a sustained way by adoptee organisations if the potential benefits of these interventions are to be realised. The multilevel Triple P system of parenting interventions is used as an example to illustrate the benefits and challenges involved in delivering a comprehensive system of parenting interventions, services, and programs. Practical implications for largescale implementation and possible future directions for research are identified.
With the adoption of a public health perspective, the target of intervention shifts from the clinical management of individual families and their children to entire populations of families and children living in defined communities. The relationship between health promotion, universal prevention, selective prevention, indicated prevention, and treatment are seen as on a continuum, and preventive and treatment approaches should ideally complement and support each other (Weisz, Sandler, Durlak, & Anton, 2005). Key concepts that inform a population-based approach to parenting support include: (a) having specific local knowledge about the base rates of child problems and associated parenting and family risk and protective factors that affect the way children are raised; (b) having knowledge from efficacy trials that shows by changing key risk and protective factors children’s problem behaviours also change; (c) making effective and culturally appropriate interventions more widely available; and then (d) tracking outcomes beyond the level of individual children and families and measuring population level indicators that are expected to shift with a parenting intervention.
Although the core five level Triple P system has features that made it a good candidate for “scaling up” the intervention, additional efforts were required to maximise the public health benefit of the intervention system. The following section illustrates steps taken to further enhance the value of the intervention as a public health strategy. The application of the RE-AIM framework of Glasgow, Vogt, and Boles (1999) provides a useful conceptual model for examining the potential public health benefit of a parenting intervention. This model argues that the public health benefit of an intervention is a function of the interaction between five factors including the reach of the intervention (R), its efficacy (E), its adoption by agencies serving the target population (A), the extent to which trained providers implement the program (I), and the extent to which they maintain or continue to use the program over time (M).
The evolution of a public health approach to the provision of parenting support over the past decade has been associated with a renewed impetus to develop interventions that reach and effectively engage parents who might benefit from support in parenting. Recent evidence showing that the implementation of population based approaches to parenting can affect rates of child maltreatment and behavioural and emotional problems is encouraging, although further research is still required (e.g., Prinz, Sanders, Shapiro, Whitaker, & Lutzker, 2009; Sanders et al., 2008; Zubrick et al., 2005). Of the many psychological interventions that can promote the well-being of children, the prospect of quality evidence based parenting programs being readily accessible to all parents holds the greatest promise to produce a future generation of healthy, happy, and resilient children with the social and emotional life skills they need to contribute to the well being of our community.