july 20, 2010 the brookings institution washington, dc
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Richard P. Barth, PhD University of Maryland School of Social Work Presented To Preventing Child Abuse in an Age of Budget Deficits A Future of Children Event. July 20, 2010 The Brookings Institution Washington, DC. Child Abuse Prevention Campaigns: - PowerPoint PPT PresentationTRANSCRIPT
University of Maryland School of Social Work
Richard P. Barth, PhDUniversity of MarylandSchool of Social Work
Presented ToPreventing Child Abuse in an Age of Budget Deficits
A Future of Children Event
July 20, 2010The Brookings Institution
Washington, DC
Child Abuse Prevention Campaigns: “Just Enough” Parent Education Campaigns
University of Maryland School of Social Work
Overview
• Developing a campaign of effective targeted parent education services is central to improved child abuse prevention– Triple P is the international leader in developing
such a campaign– Neither short- nor long- term cost-effectiveness
has yet been established, but important pieces are in place• Determination of cost effectiveness should also
include preventing conduct problems
– Parenting programs deserve singular attention
University of Maryland School of Social Work
Getting Parent Education On-Track• Parent education serves > 800,000 children
who have had contact with CWS each year
• Parent education programs have also shown efficacy in reducing conduct problems—but no national estimates are available on numbers of children or families served
• Most child abuse related parent education does not use a a strong evidence-base brand
University of Maryland School of Social Work
Parenting First Cumulative Risk Models
• Cumulative risk models of child abuse appear to fit the data better than broader ecological models (Begle, Dumas, & Hansen, 2010) – Cumulative risk indicators include many
parent-focused indicators:
• Parent abused as child
• Child’s behavior is viewed as disruptive
• Parent attributes bad behavior to child
• Parental dissatisfaction with role
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Cost-Effectiveness Improves with Targeting
• Generally, cost-effectiveness is improved by better targeting
• Fast Track, a multi-level community-based preventive intervention for conduct problems– Study was not cost-effective according to
policy maker’s willingness to pay• Fast Track was cost-effective only for youth—if at
high risk for behavioral problems (Foster & Jones, 2007)
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Multifaceted, Multi-level Campaigns
• Builds on a varied history of success of public health campaigns that promote targeting
• Triple P is the best exemplar– Multiple levels correspond to parent need and
interest – Common language– Cross-profession and agency consistency– Preliminary results are positive
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Substantial Flexibility Within Levels
Level 5: Enhanced Triple PEnhanced, Pathways
Level 4: Standard Triple PStandard, Standard Stepping Stones, Group, Group Teen,
Self-Directed
Level 3: Primary Care Triple PPrimary Care, Primary Care Teen
Level 2: Selected Triple PSeminar, Individual Support, Teen
Level 1: Universal Triple PMedia (PSAs and TV)
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Multiple Levels of Intervention
A multilevel system increases a parent’s options
• Some parents participate in Triple P as a media intervention (Level 1);
• Others attend a seminar series on positive parenting (Level 2)
• Many attend a four-session individual program with professional provider (Level 3)
• Some attended a more intensive group or individual program (Level 4)
• Others required an enhanced individual intervention that addresses parental attribution and anger (Level 5)
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Prinz’ South Carolina Test of Triple P
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Absolute Changes in South Carolina^
• Substantiated CM cases = 8% absolute increase in treatment group, smaller than in control group
• Out-of-home placements 4.27 3.75 = 12% absolute reduction
• Child CM injuries (hosp & ER) 1.73 1.41 = 18% absolute reduction
^Note that increases of CM were greater in the control group and out of home placements and CM injuries increased in the control group counties
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Child Conduct Problems• The proportion of children involved with CWS who
have behavior problems is substantial.
• 42% of children who come to the CWS have behavior problems at the clinical level at entrance (Burns et al., 2004)
• The special education, mental health, and related costs of conduct problems are substantial (Knapp et al., 2001; Scott, 2007; Cohen, 1999)
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Multiple Pathways to Savings
Effective Parent
Training
Reduction in Child Abuse
Reduction in Disruptive Behavior
Disorders
Service Costs
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Costs of Triple P
• The costs of the universal media and communication component totaled less than $1.00 per child in the population.
• The costs of training service providers to deliver at other intervention levels were quite modest ($11.74 on a per child basis) (Foster, et al., 2008)
• Rough estimates suggest that these costs could be recovered in a single year by as little as a 10% reduction in the rate of abuse and neglect.
University of Maryland School of Social Work
Short-Term Cost-Savings of Preventing Child Abuse and Behavioral Disorders
• Generally, not well-estimated—little attention has been given to the short-term service costs of: intake, court costs, placement/classroom moves, multi-disciplinary team staffing, and mental health services
• Chaffin et al. found > $3,600 savings per family in reductions in costs for new child abuse investigations after re-abuse allegations
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Conclusions re Risk Factors
• Specific forces that impair parenting are readily identifiable –Parent education may be a helpful direct
intervention for several of these conditions• Relatively little work has been done to
determine how parent education could be constructed and delivered to prevent child abuse among persons with these risk factors
University of Maryland School of Social Work
Long Term Cost of Child Abuse
• About $100,000 per child (Corso and Lutzker, 2006) or according to Foster et al., about $186,000 per family (Foster et al., 200x).
• Corso and Fertig (2010) cost of $65 billion, per child, is closer– Triple P is likely to be cost effective if it results in
more than a 10% reduction in child abuse• The reduction may have been achieved in South
Carolina, see Triple P cost-savings estimator—which uses Cohen’s estimate of $200,000 savings for “high risk youth”
University of Maryland School of Social Work
Long-term Cost of Conduct Problems
• Knapp and Scott: 3 Groups (UK), prospective study to adulthood– Conduct Problem children 3.5Xs the cost of
non conduct problem children– Conduct disordered children 3Xs the cost of
conduct problem children• Cohen (1999) prevention of “at-risk” youth status
could save $2,000,000
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Appeal of Parenting Education
• Evidence based practice has “efficiency cache”
• “The Nanny”, “Wife Swap”, and “Teen Mom” are
new TV shows that have proven popular
– Triple P has its own TV material, 6-episode
observational documentary: Driving Mum and
Dad Mad, that shows a family benefiting from
Triple P
University of Maryland School of Social Work
Funding Feasibility of Increasing Parent Education in an Age of Deficits
• The public understands that some changes in brain and bodily functioning are hugely expensive to reverse, if reversible
• BUT, Parent education does not have a “home” and is passed around between health, child welfare, schools, and mental health—depending on the intensity of the problem– A single continuum of parenting education care
would better allow for multiple investors
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Future Development of Parent Training
• A dedicated source of funding for parent education is critical to advancing evidence-based parenting programs
– The cost of failure to prevent, falls on many agencies, yet few agencies contribute to prevention
– Funding of parent training program development should be predictable so that the field can grow
– Funding should not, ultimately, be divided by “in-home” or “out of home” as many of the best parenting programs include both
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Future Development of Parent Training
• A dedicated source of funding for parent education is critical to advancing evidence-based parenting programs
• Implementation funding should not be divided by CWS or Education or Mental Health because parenting programs serve several masters
– UK has established the “National Academy of Parenting Practitioners” to develop training in evidence-based services
• Adequately accelerating parent education will require innovation at the State and Federal level
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THANK YOU
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ReferencesBegle, A. M., Dumas, J. E., & Hanson, R. F. (2010). Predicting child abuse potential: An empirical investigation of two
theoretical frameworks. Journal of Clinical Child and Adolescent Psychology, 39 (2), 208-219.
Boyle, C. L., Sanders, M. R., Lutzker, J. R., Prinz, R. J., Shapiro, C., & Whitaker, D. J. (2010). An analysis of training, generalization, and maintenance effects of Primary Care Triple P for parents of preschool-aged children with disruptive behavior. Child Psychiatry and Human Development, 41(1), 114-131.
Chaffin M., Silovsky J.F., Funderburk B., Valle L.A., Brestan E.V., Balachova T., Jackson S., & Bonner B.L. (2004).
Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports.
Journal of Consulting and Clinical Psychology, 72 (3), pp. 500-510.
Cohen, M.A. (1998). The monetary value of saving a high-risk youth. Journal of Quantitative Criminology, 14, 5-33.
Corso, P. S., & Fertig, A. R. The economic impact of child maltreatment in the United States: Are the estimates credible? Child Abuse & Neglect, 34(5), 296-304.
de Graaf, I., Speetjens, P., Smit, F., de Wolff, M., & Tavecchio, L. (2009). Effectiveness of the Triple P Positive
Parenting Program on parenting: A meta-analysis. Family Relations, 57, 553–566.
de Graaf, I., Speetjens, P., Smit, F., de Wolff, M., & Tavecchio, L. (2008). Effectiveness of the Triple P Positive Parenting Program on behavioral problems in children: A meta-analysis. Behavior Modification, 32(5), 714–735.
Embry, D. D., & Biglan, A. (2008). Evidence-based kernels: Fundamental units of behavioral influence. Clinical Child and Family Psychology Review, 11(3), 75-113.
Foster, E. M., Prinz, R. J., Sanders, M. R., & Shapiro, C. J. (2008). The costs of a public health infrastructure for delivering parenting and family support. Children and Youth Services Review, 30(5), 493-501.
Foster, E. M. & Jones, D., (2006). Can a costly intervention be cost-effective? An analysis of violence prevention. Archives of General Psychiatry, 63(11), 1284-1291.
University of Maryland School of Social Work
References (Continued)Goldfine, M.E., Wagner, S.M., Branstetter, S.A., & Mcneil, C.B. (2008). Parent-Child Interaction Therapy: An
examination of cost-effectiveness. Journal of Early and Intensive Behavior Intervention, 5(1), 119-141.
Horwitz, S. M., Chamberlain, P., Landsverk, J., & Mullican, C. Improving the mental health of children in child welfare through the implementation of evidence-based parenting interventions. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 27-39.
McCarthy, P. & Kerman, B. Inside the belly of the beast: How bad systems trump good programs. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 167-172.
Mihalopoulos, C., Sanders, M. R., Turner, K. M. T., Murphy-Brennan, M., & Carter, R. (2007). Does the triple P-Positive Parenting Program provide value for money? Australian and New Zealand Journal of Psychiatry, 41(3), 239-246.
Nowak, C. & Heinrichs, N. (2008) A comprehensive meta-analysis of Triple P-Positive Parenting Program
using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114-144.
Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-Based Prevention of Child Maltreatment: The US Triple P System Population Trial. Prevention Science, 10(1), 1-12.
Scott, S. National dissemination of effective parenting programmes to improve child outcomes. British Journal of Psychiatry, 196(1), 1-3.
Thomas, R., & Zimmer-Gembeck, M. J. (2007). Behavioral outcomes of parent-child interaction therapy and triple p-positive parenting program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35(3), 475-495.
Ward, H. (2008). Costs and consequences of placing children in foster care. London: Jessica Kingsley.