The Benefits of Positive Parenting

By DAVID BORNSTEIN

From The New York Times

Is there a science to parenting?

For all the current discussion in the United States about gun violence and mental illness, there has been little attention paid to root causes. Any effort aiming to reduce gun violence — or child abuse, intimate partner violence, suicide or sexual abuse — must include a serious discussion about how society can improve the quality of parenting.

In 2010, children’s protective service agencies investigated 1.8 million referrals of child abuse and neglect pertaining to 3 million children. Although only 20 percent of these were substantiated, researchers report that physical abuse, including harsh physical discipline that is equivalent to abuse, is vastly underreported and may be 20 times more prevalent than is reflected in official statistics. (In other countries, including Spain, India and Egypt, harsh punishment is even more prevalent.) In Philadelphia, this behavior has recently been linked to the recession and the rate of mortgage foreclosures. When lenders put people out of their homes, one unforeseen consequence is that more kids end up with traumatic brain injuries.

It is now well accepted that physical discipline is not only less effective than other non-coercive methods, it is more harmful than has often been understood — and not just to children. A review of two decades worth of studies has shown that corporal punishment is associated with antisocial behavior and aggression in children, and later in life is linked to depression, unhappiness, anxiety, drug and alcohol use and psychological maladjustment. Beyond beating, parents can also hurt children by humiliating them, labeling them in harmful ways (“Why are you so stupid?”), or continually criticizing their behavior.

Improving the way people parent might seem an impossible challenge, given the competing views about what constitutes good parenting. Can we influence a behavior that is rooted in upbringing and culture, affected by stress, and occurs mainly in private? And even if we could reach large populations with evidence-based messages the way public health officials got people to quit smoking, wear seat belts or apply sunscreen, would it have an impact?

That’s what was explored in South Carolina in recent years, and the answer appears to be yes. With funding from the Centers for Disease Control and Prevention, a parenting system called the Triple P – Positive Parenting Program, which was developed at the University of Queensland, Australia, was tested in nine counties across the state. Eighteen counties were randomly selected to receive either a broad dissemination of Triple P’s program or services as usual. The results were both highly promising and troubling.

The good news was that, in contrast to the control counties, over two years, the nine counties that received the Triple P Program had a 35 percent reduction in hospitalizations and emergency room visits for child injuries, a 44 percent reduction in out-of-home placements, and a 28 percent reduction in substantiated cases of abuse. The bad news was that the Triple P counties mainly held their ground, while abuse increased elsewhere in the state, possibly because of the recession and the concomitant budget cuts in children’s protective services.

The Triple P Program has evolved over the past 35 years. It focuses on families with children under age 12 and has shown efficacy in numerous studies. It started as a home visiting program, but researchers found it too expensive to deliver more widely, so they looked for ways to broaden its reach – to get good parenting into the water supply. “You know how vast Australia is,” explains Matthew Sanders, Triple P’s founder. “Our question was how do we ensure that all families, regardless of where they lived, could access good quality evidence-based parenting interventions.” Sanders experimented with different dissemination techniques, including telephone consultations, and found that they could do just as well as face-to-face meetings.

What’s notable about Triple P is that it pursues a community-wide, preventive approach. Sanders believes that all parents would benefit from some education — though some need a light touch while others need significant help. And why would it be otherwise? Unlike driving a truck or teaching, no one needs a permit to become a parent. We copy others and make it up as we go. Without a “reflective awareness” and the benefit of information, says Sanders, parents are apt to struggle with strategies that don’t work – or that work for some children, but not others. He has seen a great deal of conflict and unhappiness and violence-begetting rage and humiliation that could have been averted with manageable changes.

Triple P works at multiple levels, ranging from media and communication strategies (TV, Web, radio, newspapers) to brief individual consultations and group sessions to intensive parenting and family interventions for serious difficulties. “You need to get lots of practitioners from different sectors — education, day care, mental health, health, social services, pastoral counseling – who are trained to work with parents and families and give them an added skill,” explained Ron Prinz, the director of the Parenting and Family Research Center at the University of South Carolina, who led the Triple P study. “Parents need different ways to get exposed to it.” In the nine counties in South Carolina, 649 people received training (three to six days on average) to deliver the program.

For parents, exposures can range from watching a video to participating in two 20-minute phone calls to attending 14 group sessions. “We follow the principle of ‘minimal sufficiency,’ ” says Sanders. “Use the smallest possible intervention to solve or prevent a problem.”

There are dozens of strategies and variations for parents — those who have children with disabilities, chronic illnesses, obesity or emotional difficulties, as well as those going through separation or divorce or at risk of maltreating their children. Parents discover techniques like “planned ignoring” (good for low-level misbehavior like whining or minor tantrums where the goal is attention) or learn how to escape the “escalation trap,” which occurs when parents get exasperated.

The essence of the research is that children do best when they receive calm and consistent feedback and assertive discipline that’s based on reasonable expectations – with significantly more encouragement and positive feedback than criticism. “The main mistake parents make is forgetting the importance of catching kids doing the right thing,” says Sanders.

Stephanie Romney, director of the Parent Training Institute at the San Francisco Department of Public Health, agrees. Romney and her colleagues deliver higher level Triple P interventions to 1,000 families, many of whom are involved with children’s services. “Typically, the children have been on the receiving end of a lot of negative attention from adults,” she said. “Even if the child has misbehaved all day, their parents try to catch them for that brief window when they are behaving well and praise them.” Parents are sometimes amazed by the changes. “I’ve had parents tearing up talking about how their relationship with their child has improved,” she added. “They went for a walk together and held hands for the first time. And parents report that they try it out on their spouses and coworkers and it works with them, too.”

Triple P is one of several evidence-based parenting programs that have demonstrated how society can reduce behaviors that put children at risk. Some others include SafeCareParent Management Training – the Oregon ModelThe Incredible Years and Nurse Family Partnership. What is different here is the idea that parenting education could be broadly disseminated. This is important, because parenting training needs to be de-stigmatized. It’s not just about reducing abuse.

Romney notes that one of Triple P’s strengths is that it presents a multiplicity of strategies and leaves it to parents to decide which ones to use. The community approach comes with limitations, however. It’s difficult to get parents to come in if they aren’t required to and it involves training numerous people to deliver the program – so start-up costs can be a barrier. But a lot of Triple P’s teachings are available online. And unlike many parenting blogs, the advice is supported by research.

Parenting doesn’t get much attention in policy circles. “We don’t have mechanisms that help people to understand that parent education and training can be very effective,” explains Richard Barth, dean of the University of Maryland School of Social Work, who has studied parenting programs for 30 years. “The Triple P study showed that if you engage people before things go awry, they can avoid problems that we might have predicted for them, or they might have predicted for themselves. There should be a significant investment in understanding how to implement some of the elements of Triple P — so every family and clinician in the United States knows the basics of parenting and the things we can do if things get more difficult.”

It’s not just for children. “It really influences adult well-being, too” Sanders said. “Parents become less stressed, less angry, less depressed, and have less conflict with their partners. We now have research that shows that parenting interventions improve your capacity to function at work, too.”

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