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Empirically Guided Community Intervention for Partner Abuse, Child Maltreatment, Suicidality, and Substance Misuse

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Book cover Risk and Resilience in U.S. Military Families

Abstract

This chapter describes an initial implementation and evaluation of NORTH STAR, a community-based framework for the prevention of family maltreatment, suicidality, and substance problems. NORTH STAR was evaluated using existing installation-level prevention teams at 24 U.S. Air Force bases worldwide in the context of a randomized controlled trial (RCT). NORTH STAR organizes teams’ prevention efforts by (a) providing the results of a needs assessment focused both on problems and risk/promotive factors, (b) prioritizing among problems and associated factors, (c) implementing activities from a menu of empirically supported community-based initiatives for each risk factor, (d) evaluating those activities, and (e) ensuring sustainability through a reliance on preexisting resources. NORTH STAR had promising results, appearing to reduce some problems, especially in communities with more adverse prevention climates. The implications of our efforts for community-wide prevention generally and within the U.S. Air Force are considered.

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Notes

  1. 1.

    Beginning in 2008, a fourth behavioral health protection threat – Post-Traumatic Stress Disorder (PTSD)/Combat Operational Stress Reaction (COSR) – was added to this project’s purview.

  2. 2.

    NORTH STAR is an acronym for New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness.

  3. 3.

    Data as of January 2010 derived from the Air Force Personnel Center’s Interactive Demographic Analysis System (wwa.afpc.randolph.af.mil/demographics/).

  4. 4.

    A tenth major command, the Air Force Reserve Command, is responsible for the 35 AF Reserve wings.

  5. 5.

    Despite a relatively large effect (d = 0.57), this effect did not reach statistical significance.

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Author information

Authors and Affiliations

  1. Family Translational Research Group, Department of Psychology, Stony Brook University, State University of New York, Stony Brook, NY, 11794-2500, USA

    Richard E. Heyman

Authors
  1. Richard E. Heyman
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  2. Amy M. Smith Slep
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  3. John P. Nelson
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Corresponding author

Correspondence to Richard E. Heyman .

Editor information

Editors and Affiliations

  1. Dept. Child Development & Family Studies, Purdue University, Gates Rd. 101, West Lafayette, 47907, Indiana, USA

    Shelley MacDermid Wadsworth

  2. Health Sciences, Dept. Medical & Clinical Psychology, Uniformed Services University of the, Jones Bridge Road 4301, Bethesda, 20814-4799, Maryland, USA

    David Riggs

Appendices

Appendix: Triple P (Ages birth-12)

Intervention targets

Community

Organization

Family

Individual

 

Child externalizing behavior problems (Levels 1–5)

Parents’ sense of competence (Levels 1–5)

Parent–child relationships (Levels 1–5)

Relationship satisfaction

Family coping

Child internalizing behavior problems (Levels 4 and 5 only)

Depressive symptoms (Levels 4 and 5 only)

Personal coping

Anxiety (Levels 4 and 5 only)

Description

Triple P (“Positive Parenting Program”) is a multi-level family support strategy that aims to prevent severe behavioral, emotional, and developmental problems in children by enhancing the knowledge, skills, and confidence of parents.

Originally developed in Australia, Triple P was designed around the idea that parents have differing needs and desires regarding the type, intensity and mode of assistance that they may require. The Triple P system is designed to maximize efficiency, contain costs, and ensure that the program has wide reach in the community. Thus, Triple P consists of five possible levels of intervention for parents of children from birth to age 12. The five levels are of increasing intensity, as described below. Families can enter the Triple P system of intervention at any level. The system does not require families to progress from the least to most intensive level of intervention, although this may occur. Having completed one level of Triple P does not mean a particular family cannot complete another, and some families should certainly be encouraged to do so.

  • Level 1: A community-wide, multimedia parent information campaign. Goals include promoting awareness of parenting issues and normalizing participation in parenting programs such as Triple P.

  • Level 2: A very brief, 1- or 2-session primary care intervention for parents of children with mild behavior problems. Parents receive specific advice on how to solve common child developmental issues (e.g., potty training) and minor child behavior problems (e.g., bedtime problems).

  • Level 3: A brief primary care program for parents of children with mild to moderate behavior difficulties. The program combines advice with active skills training as required to teach parents to manage a discrete child problem behavior (e.g., tantrums, fighting with siblings).

  • Level 4: A broadly focused parenting program for parents who want or need intensive training in positive parenting skills (often, these are parents of children with more severe behavior problems). Parenting skills are taught and practiced across a range of target behaviors, settings, and children.

  • Level 5: An intensive, individually tailored program for families where parenting difficulties are complicated by other sources of family distress (e.g., relationship conflict, parental depression, and/or high levels of stress). Possible program elements include practice sessions to enhance parenting skills, mood management and stress coping skills, and partner support skills.

Minimal Implementation

Bases implementing Triple P as part of NORTH STAR may choose to apply any one or any combination of the five levels. Implementation by level involves the following:

  • Level 1: Community-wide use of print and electronic media and other health promotion strategies. May include some contact with professional staff (e.g., via telephone).

  • Level 2: Guidance with the aid of user-friendly parenting tip sheets and videotapes that demonstrate specific parenting strategies. May involve either (a) about 20 minute (total over two sessions) of face-to-face or telephone contact with a primary care service provider or (b) a 60–90 minute seminar. Level 2 providers may come from maternal and child health services, family health care, childcare centers, kindergartens, preschools, schools, and/or other community agencies that offer parent support.

  • Level 3: About 80 min (total over four sessions) of either face-to-face or telephone contact with a primary care service provider. Same potential providers as Level 2.

  • Level 4: About 10 h (total over 8–10 sessions). Possible formats include individual, group (groups usually consist of 10–12 parents), or self-directed (with or without telephone assistance) options.

  • Level 5: Up to 11 face-to-face, individualized sessions lasting 40–90 minute each.

Documented Results (Empirical Evidence: Best)

All five levels of Triple P are being rigorously validated (for reviews see Sanders, 1999; Sanders, Turner, & Markie-Dadds, 2002). In general, all five levels have been found to reduce child behavior problems, increase parents’ sense of competence, and improve parent–child relationships. As might be expected, families who participated in more intense versions of the program generally tended to see more dramatic results. In addition, the two highest levels (i.e., 4 and 5) of Triple P have demonstrated the following effects:

  • Reduced mothers’ depression

  • Reduced mothers’ and children’s anxiety

  • Improved children’s self-esteem

  • Reduced parental stress

  • Reduced marital conflict and increased marital satisfaction

  • Improved parents’ perceived ability to work together as a team

Resources Required

Required resources will vary greatly depending on the level(s) to be implemented. However, the materials and training necessary for any and all of the five levels are available from Triple P International or Triple P America. Training courses are conducted either at Triple P America headquarters in South Carolina or on-site and are available for levels 2 and 3 (combined) and levels 4 and 5 (combined or separate). Each course is presented to up to 22 trainees and lasts 3–6 days total, with the final day of training scheduled 6–8 weeks following completion of the rest of the course. Training ranges in price from about $500 to $1,500 per participant, plus travel, lodging, and materials.

Where to Find More Information

For training and materials in the United States, contact:

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Heyman, R.E., Slep, A.M.S., Nelson, J.P. (2011). Empirically Guided Community Intervention for Partner Abuse, Child Maltreatment, Suicidality, and Substance Misuse. In: Wadsworth, S., Riggs, D. (eds) Risk and Resilience in U.S. Military Families. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7064-0_5

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