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 2 Prevent Child Abuse Arizona would like to thank Our current Triple P funders: Our prior Triple P funder:
Today’s Session 3 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? 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 Blueprints Certified Meeting the highest standards of evidence through independent review by the nation’s top scientists
Translating Research into Practical Interventions 5 Holder of Intellectual Property University Technology Transfer Company Professor Matt Sanders Licensed Content Primary Researcher/Developer Triple P Providers Practitioners Consultant 501c3 Organizations Public Agencies Others Triple P International Training Global Research Technical Assistance Community & Resources Triple P Global Offices
Triple P’s Evidence Base 6
What is Triple P? An evidence-based population approach for improving parenting practices and children’s social and emotional well-being. 7 Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information. Encounters Improves parent anger management, coping with stress, co- 4-14 parenting; reduces child obesity, behavior problems Intensive family intervention Improves parent-child relationships, encourages and teaches 8-10 positive behaviors, manages misbehavior Intervention Broad parent training Intensity Improves ways of handling common behavior problems and 1-4 developmental challenges Narrow parent training Brief consults for discrete problems, seminars for raising resilient 1-3 kids and conveying positive parenting strategies Brief consults/Seminars Outreach and media strategy for de-stigmatizing parent 0 education and facilitating referrals Media strategy Population Reach 7
What is Triple P? An evidence-based population approach for improving parenting practices and children’s social and emotional well-being. 8 Tiered interventions enable different service delivery providers to offer the program and gives families options in receiving parenting information. Encounters Improves parent anger management, coping with stress, co- 4-14 parenting; reduces child obesity, behavior problems Intensive family intervention Improves parent-child relationships, encourages and teaches 8-10 positive behaviors, manages misbehavior Intervention Broad parent training Intensity Improves ways of handling common behavior problems and 1-4 developmental challenges Narrow parent training Brief consults for discrete problems, seminars for raising resilient 1-3 kids and conveying positive parenting strategies Brief consults/Seminars Outreach and media strategy for de-stigmatizing parent 0 education and facilitating referrals Media strategy Population Reach 8
What is Triple P? An evidence-based population approach for improving parenting practices and children’s social and emotional well-being. 9 Cognitive-behavioral content Practitioners Parents Observe Model Positive Analyze Instruct Parenting Strategies Practice Role play Neurodevelopmental functioning Self- Plan ahead Discuss Regulation Self reflect Collaborate Adjust Facilitate Insight-oriented process Principles of Positive Parenting Assertive Realistic Taking care of Safe & engaging Positive learning discipline expectations yourself environment environment
10 Triple P Strategies Re-organization of parenting time Ground rules, directed discussion, Manage and effort from overly harsh or Challenging planned ignoring, clear, calm instructions, Behaviors lax practices to ones that logical consequences, quiet time, build attachment and time-out positive parent-child relationships. Modelling, incidental teaching, Teach New Skills & ask-say-do, behavior charts Behaviors Re-setting the set point for family hostility and conflict Praise, positive attention, Encourage Positive Behaviors engaging activities Re-orienting parents to the power of love Brief quality time, talking to Develop Positive Relationships children, affection TEMPERAMENT X ATTACHMENT STYLE X POSITIVE PARENTING = CHILD SELF - REGULATION
Learning to Self-Regulate A self-regulating individual: – Guides their own behavior – Copes with powerful emotions – Demonstrates self-control – Manages their thoughts and I want the whole world beliefs Veruca Salt – Focuses attention, problem Blaming the kids is a lie and a shame. You know exactly who's to blame: solves, and organizes their The mother and the father! Oompa Loompas 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 Parents with mental health or substance abuse problems are more likely to have impaired capacity to regulate their I want the whole world cognitions, emotions, and Veruca Salt behavior. 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?
Bringing Triple P to Arizona’s Families 13 Keynote Presentation PCA AZ CAP Conference 2009 2010 2012 2014 2011 2013 Early Adopters Triple P Developer, Local AZ Org Runs 1 st Pilot of Triple P On-Line Professor Matt Sanders Triple P Parenting Forum at PCH
Bringing Triple P to Arizona’s Families 14 Triple P as Part of the State Opioid Response Triple P Capacity Building Grant to PCA AZ Grant to PCA AZ Expanding Triple P in Maricopa County FYs 2019, 2020 CYs 2015-2017 Grant to PCA AZ CYs 2018-2020 2015 2016 2018 2020 2017 2019 PCA AZ Triple P Community Forum and Prof Sanders’ Master Class for AZ Practitioners
PCA AZ Grant-Funded Triple P Training 15 20 20 15 + Steele Cohort 1: Piper Cohort 1: Cost-Sharing Opportunity Level 4 Standard Level 3 Primary Care Stepping Stones Extension 20 15 20 + Piper Cohort 2: Cost-Sharing Opportunity Steele Cohort 2: Level 4 Group Stepping Stones Extension Level 4 Group 12 20 20 Steele Cohort 3: + Piper Cohort 3: Level 3 Primary Care Level 4 Standard Level 5 Pathways Extension (shared cohort with MCDPH)
Maricopa County Triple P To-Date 16 Calendar Years 2015-2018 1,863 Triple P Services GROUP STANDARD 2,064 1,064 Parents 269 Parents Parents/Caregivers Served Level 4 Triple P 458 BRIEF 20 DISCUSSION CONSULTATIONS GROUPS 224 Parents 118 Parents Level 3 Triple P 52 SEMINARS 389 Parents Level 2 Triple P Small Group Format 1:1 Services Population Reach
Maricopa County Triple P Outcomes 17 Cli nically 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. 8 7 7 out of 10 Maricopa County out of 10 who participated in Level out of 10 reported that the parents/caregivers reported the 4 Standard or Level 4 Group Triple P program helped them to deal highest quality ratings for Level 4 reported that the program helped more effectively with problems Standard and Level 4 Group Triple P them to deal more effectively with that arise in their families their children’s behavior
Scope of the US Opioid Crisis 18 From 1999 to 2017, more than 700,000 people have died from a drug overdose. Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid. In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999. 130 people in the United States die each day after overdosing on opioids Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. About 80 percent of people who use heroin first misused prescription opioids. In 2016, an estimated 11,824,000, or 4.4% of persons aged 12 and older, reported opioid misuse in the past year By gender, reported opioid misuse was 4.9% among males and 3.9% among females. 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 19
AZ Prescription Rates Decline source: drugabuse.gov 20
AZ DHS Real-Time Data 21 https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php
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