Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
Acknowledgments
The completion of this research project would not have been possible without the work and dedication of many
community partners and Region of Waterloo Public Health staff. Many thanks for the contributions of the following
individuals and organizations into the work of the Positive Parenting Evidence and Practice-based Planning
Framework:
For the insightful information they provided in regards to positive parenting practices in Waterloo Region and across
the province:
Community partners across Waterloo Region
Peer Public Health Units across Ontario
For their commitment to the cause and input:
The Positive Parenting Community Committee members
For sharing valuable organizational data:
KW YMCA Ontario Early Years Centre Data Analysis Coordinator
Family and Children’s Services of the Waterloo Region
Front Door
KidsAbility
For their permission to use their materials and information:
Incredible Years
Public Health Agency of Canada (Canadian Best Practices Portal)
The Phoenix Centre
Triple P- Positive Parenting Program
For their guidance and feedback:
The Positive Parenting EPPF Advisory Committee members (current and past):
Sheri Armstrong
Jessica Deming
Gayle Jessop
Lori Snyder-MacGregor
Ishan Angra
Pat Fisher
Tonya Lavallee
Debbie Wang
Ruth Cordukes
Jackie Good
Andrea Reist
Natalie Wunder-Zettler
Tammany Crawford
Sharmin Jaffer
Dianne Roedding
For their hard work and dedication:
The Positive Parenting EPPF Working Group members (current and past):
Laura Armstrong
Fauzia Baig
Lindsey Cordingley
Sheri Armstrong
Lindsay Benson
Tonya Lavallee
Eve Nadler
Debbie Wang
For their direction and support:
Heidy Choi-Keirstead
Andrea Reist
Sharmin Jaffer
CFH Management Team
For their valuable insight into actions:
Cross-divisional managers in Region of Waterloo Public Health
For their detailed review, guidance, and graphic design:
Grace Bermingham
Pat Fisher
Andrea Reist
Heidy Choi-Keirstead
Sharmin Jaffer
Lindsay Steckley
Jessica Deming
Lu-ann Procter
Aimee White
For their support in data requests, analysis, and research ethics and process:
Jessica Deming
Pat Fisher
Stephen Drew
Amanda Tavares
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
2
Prepared by Erin Tardiff
For further information regarding this report contact:
Child and Family Health, Region of Waterloo Public Health
519-883-2000
Suggested Citation:
Region of Waterloo Public Health. (2012, April). Positive Parenting in Waterloo Region: Exploring a Comprehensive
Approach. Final Report. Waterloo, ON: Erin Tardiff
Copyright Statement:
Subject to the following limitations, this resource may be reproduced, stored in a retrieval system,
and transmitted in any form and by any means as long as the source is acknowledged. No part of
this resource may be used or reproduced for commercial purposes or to generate monetary profits. Written
permission is required if any adaptations or changes are made. This permission does not cover the use or
reproduction of any third-party copyrighted material which appears in this resource. Written permission to
use such material must be obtained from the cited source.
© Region of Waterloo Public Health, 2012.
For full documentation of the research methodology and limitations see:
Region of Waterloo Public Health. (2012, April). Positive Parenting in Waterloo Region: Exploring a Comprehensive
Approach. Evidence and Practice-based Planning Framework (EPPF) Technical Report. Waterloo, ON: Erin Tardiff
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
3
Table of Contents
Table of Contents .................................................................................................................................. 4
List of Figures ....................................................................................................................................... 6
List of Tables ........................................................................................................................................ 6
Glossary of Acronyms/Abbreviations....................................................................................................... 7
Executive Summary ............................................................................................................................... 8
1.0 Introduction ................................................................................................................................... 11
1.1 Overview ........................................................................................................................................11
1.2 Region of Waterloo Public Health Context ..........................................................................................11
1.3 Methodology ...................................................................................................................................11
1.4 Research questions .........................................................................................................................12
2.0 Literature Review ........................................................................................................................... 13
2.1 Literature Review Process ................................................................................................................13
2.2 Literature Review Summary .............................................................................................................13
How is positive parenting defined in the literature? ...............................................................................13
Why is positive parenting important? ...................................................................................................15
What is a positive parenting strategy? .................................................................................................17
What are the key components in effective positive parenting strategies? ................................................18
What is a comprehensive approach to positive parenting? ....................................................................21
Are there strategies in the literature that fulfill the definition of an evidence-based, comprehensive
approach to positive parenting? ..........................................................................................................23
What does the literature say about other parenting strategies? ..............................................................25
Who are the priority populations for a positive parenting strategy? .........................................................28
What other issues need to be considered? ..........................................................................................32
3.0 Environmental Scan........................................................................................................................ 34
3.1 Positive Parenting Community Forum ................................................................................................34
3.2 Positive Parenting Community Inventory Survey .................................................................................34
3.3 What positive parenting activities does ROWPH lead? ........................................................................39
3.4 Public Health Unit Survey .................................................................................................................40
3.5 What do parents have to say?...........................................................................................................43
3.6 Limitations ......................................................................................................................................44
4.0 Priority Populations ........................................................................................................................ 44
4.1 Local data to confirm priority populations ...........................................................................................46
Methodology .....................................................................................................................................46
Limitations ........................................................................................................................................47
One Stop Project priority populations ..................................................................................................47
Priority Population: Families with children 0 to 6 years of age ................................................................48
Priority Population: Families at high risk for negative health outcomes ...................................................48
Priority Population: Families living in low income or socially disadvantaged neighbourhoods ....................48
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
4
Priority Population: Families involved with child protection services (or have experienced or witnessed
abuse or neglect) ..............................................................................................................................50
Priority Population: Families led by a young parent or parents ...............................................................53
Priority Population: Families who are New Canadians, immigrants, refugees, parenting in two cultures .....54
Priority Population: Families living in rural areas...................................................................................55
Priority Population: Families with children with special needs (children with conduct disorders,
developmental disability, mental health concerns, and/or who are gifted or talented) ...............................56
Summary remarks: Who are the priority populations for positive parenting interventions in Waterloo
Region? ...........................................................................................................................................56
5.0 Gaps Analysis ................................................................................................................................ 56
6.0 Best Practices ................................................................................................................................ 62
7.0 Suggested actions .......................................................................................................................... 62
8.0 Conclusion .................................................................................................................................... 63
Appendices ........................................................................................................................................ 64
Endnotes ............................................................................................................................................ 91
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
5
List of Figures
Figure 1 Invest in Kids' positive parenting definition ........................................................................................... 14
Figure 2 Incredible Years Program Model ......................................................................................................... 24
Figure 3 Proportion of positive parenting activities by age range that positive parenting activities are geared towards
(years), Waterloo Region, 2011 ....................................................................................................................... 36
Figure 4 Proportion of positive parenting activities by health promotion strategy types, Waterloo Region, 2011 ....... 37
Figure 5 Number of positive parenting activities by targeted age category and type of health promotion strategy,
Waterloo Region, 2011 ................................................................................................................................... 38
Figure 6 Proportion of ROWPH positive parenting activities by elements of positive parenting, ROWPH, 2011 ....... 39
Figure 7 Number of ROWPH positive parenting activities by health promotion strategy type and age category (years),
ROWPH, 2011 ............................................................................................................................................... 40
Figure 8 Proportion of PHU positive parenting activities by age and by PHU, 2011 ............................................... 41
Figure 9 Number of PHU positive parenting activities by health promotion strategy type, 2011 .............................. 42
Figure 10 Neighbourhood-level risk factors by neighbourhood economic security index (NESI) level, Waterloo
Region, 2006, 2010 ........................................................................................................................................ 49
Figure 11 Proportion of FACS clients by primary reasons for referral at intake, Waterloo Region, 2010/2011 .......... 50
Figure 12 Number of FACS active protection cases by age, Waterloo Region, 2010 ............................................. 51
Figure 13 Proportion of mothers screened with Larson who were involved with FACS prenatally by age of mother,
Waterloo Region, 2010 ................................................................................................................................... 52
Figure 14 Mean proportion of population 0 to 18 years with active FACS cases by NESI, Waterloo Region, 2006,
2010 ............................................................................................................................................................. 53
Figure 15 Proportion of infants at risk on Larson by mother’s age, Waterloo Region, 2010 .................................... 54
Figure 16 Risk factor data by rural versus urban populations, Waterloo Region, 2010........................................... 55
Figure 17 Locations of organizations with positive parenting programs, by neighbourhood and NESI score, Waterloo
Region, 2006, 2011 ........................................................................................................................................ 59
Figure 18 Locations of organizations with positive parenting programs for children aged 13 to 18 years, by
neighbourhood and NESI scores, Waterloo Region, 2006, 2011 ......................................................................... 60
Figure 19 Positive parenting activities by neighbourhood and population of children aged 0 to 18 years, Waterloo
Region, 2006, 2011 ........................................................................................................................................ 61
List of Tables
Table 1 Overview of project phases ................................................................................................................. 12
Table 2 Tangible and intangible supports that parents seek, Canada, 2006 ......................................................... 43
Table 3 Comparison of identification of priority populations ................................................................................ 46
Table 4 Gaps in services for priority populations, Waterloo Region, 2011 ............................................................ 57
Table 5 Population projections children aged 0 to 6, Waterloo Region, 2006........................................................ 62
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
6
Glossary of Acronyms/Abbreviations
ASD
BNP
CFH
EDI
EPPF
FACS
FAST
Group
HBHC
Incredible Years
Individual
ISCIS
LGTBQIA
Multidisciplinary
NESI
ODD
OPHS
PCIT
PHU
Policy
RCT
RRFSS
ROWPH
Self-help
Social marketing
Triple P
VIPP
Autism Spectrum Disorder
Bavolek Nurturing Program
Child and Family Health
Early Development Instrument
Evidence and Practice-based Planning Framework
Family and Children’s Services of the Waterloo Region
Families and Schools Together
Group parent education or parent training
Healthy Babies Healthy Children
The Incredible Years Program
Individual parent education or parent training
Integrated Services for Children’s Information System
Lesbian Gay Transgender Bisexual Questioning Intersex Asexual
Multidisciplinary approach
Neighbourhood Economic Security Index
Oppositional Defiance Disorder
Ontario Public Health Standards
Parent-Child Interaction Therapy
Public Health Unit
Policy development
Randomized Control Trial
Rapid Risk Factor Surveillance System
Region of Waterloo Public Health
Self-help, mutual aid or peer approaches
Social marketing and/or health communication
Triple P Positive Parenting Program
Video-feedback Intervention to promote Positive Parenting
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
7
Executive Summary
Positive parenting is an approach to parenting that encourages building a close relationship between parent and
child; that emphasizes setting up consistent, clear boundaries for children; and that promotes non-punitive
consequences for negative behaviour. Positive parenting practices are associated with positive behavioural
outcomes for children and decreased stress for parents. Children, who have a close, nurturing relationship with
their primary caregivers, feel more secure in exploring their environment, leading to more positive experiences
that shape their development. Conversely, harsh or abusive parenting has been found to lead to the development
of behavioral and emotional problems for children, which can have long-term effects such as higher risk for
substance abuse issues, school drop out, and juvenile delinquency.
Positive Parenting in Waterloo Region: Exploring a Comprehensive Approach project was initiated in December 2010
for two reasons. First, exploration and identification of strategies to address gaps in meeting positive parenting
requirements as listed in the Ontario Public Health Standards (OPHS) was needed. In addition, a situational
assessment conducted by Region of Waterloo Public Health (ROWPH) called “One Stop” provided a
recommendation to explore community interest in a community-wide, comprehensive approach to positive parenting
to better meet the needs of families with young children. A research framework with multiple components guided the
positive parenting research process and included a literature review, surveys of local positive parenting programs
and programs of other Public Health Units (PHUs), a process to set priority populations, and a gaps analysis. The
following research question guided this work:
Within the context of the OPHS requirements, what is ROWPH’s role in a comprehensive positive
parenting approach in Waterloo Region for parents of children prenatal to 18 years?
A comprehensive positive parenting approach encompasses different levels of intervention, including prevention, that
provide both targeted interventions as well as population-based strategies based on the needs of the community, and
involve various service providers offering multiple access points for families.
The literature review yielded the following key findings:
•
•
•
Positive parenting practices are important in shaping the development of children, including brain,
emotional, cognitive, physical, and behavioural development. Positive parenting programs are especially
effective when they increase parents’ self-efficacy, provide time for direct practice, and are offered within a
comprehensive system of programs and interventions.
Social marketing campaigns that work towards reducing the stigma of accessing parental supports can help
to engage more parents.
Key elements of a comprehensive approach include a multidisciplinary approach with multiple access
points; multiple delivery methods of positive parenting activities so that interventions can meet the comfort
level and needs of families; a service delivery system that covers services for a wide age range of children
for parents to continue to access services as their child grows; and coordination between services so that
parents can easily access the most appropriate intensity level of interventions suited to their changing
needs.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
8
The community forum yielded the following key findings:
•
•
•
•
Questions remain about how a comprehensive positive parenting approach would exist in Waterloo Region.
There was a desire to work together to explore this further starting with what currently exists in this
community.
Acknowledgement that there are great benefits for parents and community partners in working together to
provide supports and services for families in this community.
The Positive Parenting Community Committee developed as a result of the forum.
The survey of positive parenting programs in Waterloo Region yielded the following results:
•
•
•
•
•
Sixty organizations offer 158 positive parenting activities in Waterloo Region.
When viewed together, positive parenting services provided in Waterloo Region seem to cover the key
elements of a comprehensive strategy, with a few exceptions.
The degree to which coordination and multiple tiers of positive parenting intervention are provided in
Waterloo Region requires further exploration.
The two evidence-based, comprehensive approaches (Triple P – Positive Parenting Program and Incredible
Years) found in the literature review are not being offered in Waterloo Region in the comprehensive sense.
A total of 20 positive parenting activities are being led by ROWPH covering the age range from prenatal to
18 years, include both universal and targeted approaches, and cover all of the health promotion strategies
identified in the literature. The majority of ROWPH positive parenting activities were not developed based on
specific evidence and have not been evaluated.
The survey of PHUs in Ontario yielded the following key findings:
•
•
A variety of strategies are being used by PHUs to address the OPHS requirements.
Some PHUs are involved, either leading or collaborating, in evidence-based, comprehensive approaches to
positive parenting programs.
An important goal of this research was to identify priority populations for whom positive parenting interventions may
be most important i.e., groups or communities that tend to experience health inequalities or social disadvantages,
and for whom organizations may need to develop specific or unique interventions. Based on the literature, the
community survey, the survey of PHUs, and consultation with the project advisory committee, the following priority
populations were identified:
•
•
•
•
•
•
•
•
Families with children 0 to 6 years of age
Families at high risk for negative health outcomes
Families living in low income or socially disadvantaged neighbourhoods
Families involved with child protection services (or have experienced or witnessed abuse or neglect)
Families led by a young parent or parents
Families who are New Canadians, immigrants, refugees, parenting in two cultures
Families with children living in rural areas
Families with children with special needs (children with conduct disorders, developmental disability, mental
health concerns, and/or who are gifted or talented)
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
9
The following three questions guided the gaps analysis:
1. Are the elements of a comprehensive approach covered in Waterloo Region?
2. Are there activities for each of the strategies covered for priority populations in Waterloo Region?
3. Are the positive parenting activities located in places accessible to those who need them, i.e., in their
neighbourhood?
The gaps analysis yielded the following key findings:
•
•
•
•
•
The degree to which coordination and multiple tiers of positive parenting intervention are provided in
Waterloo Region requires further exploration.
The two evidence-based, comprehensive approaches (Triple P – Positive Parenting Program and Incredible
Years) found in the literature are not happening in this community in the comprehensive sense.
There are gaps in services for priority populations, especially in the areas of social marketing and policy
development.
There are areas in Waterloo Region with less access to positive parenting activities. For example, the rural
areas have the least number of positive parenting activities located in their communities. Positive parenting
activities are also not consistently located in neighbourhoods with the highest populations of children 0 to 18
years.
Further research is needed to examine whether there is unmet need with respect to positive parenting
intervention, and the extent of that need.
More research is needed to identify best practices for positive parenting programs.
In sum, there appear to be many supports for parents in Waterloo Region. What remains to be answered is to what
degree the coordination that is critical to a comprehensive approach, and seamless service for families, is already
happening. Providing a comprehensive approach to positive parenting for families in Waterloo Region will allow
service providers to reach out to the widest audience of families and have the greatest impact on population health.
As identified through initial consultations with stakeholders on what the findings mean for this community, further
exploration of a comprehensive approach to positive parenting in Waterloo Region will need to involve the following
community discussions:
•
•
•
•
What is the current level of coordination among organizations and how can it be increased?
How to address the gaps identified in this report and do they represent unmet needs in the community?
Is implementing an evidence-based, comprehensive approach an option for this community?
How can policy development be used to further positive parenting messages in the community?
The next step in this process includes sharing the findings from the work of Region of Waterloo Public Health and the
Positive Parenting Community Committee more broadly with community partners to discuss what direction Waterloo
Region should take in regards to positive parenting.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
10
1.0 Introduction
1.1 Overview
“A positive parent is a loving, understanding, reasonable and protective teacher and model” (1). 1
In December 2010, the Positive Parenting in Waterloo Region: Exploring a Comprehensive Approach project was
initiated to explore the potential role of Region of Waterloo Public Health (ROWPH) in a community-wide,
comprehensive positive parenting strategy.
This report will be used to support community dialogue in exploring a comprehensive approach to positive parenting
in Waterloo Region. It is further hoped that this work will provide information that could be used to inform strategic
and program planning related to the spectrum of ROWPH programs for families with children.
1.2 Region of Waterloo Public Health Context
The following objectives guided this work:
1. To identify ways that ROWPH could better meet the Ontario Public Health Standards (OPHS)
requirements for positive parenting (see Appendix A), and
2. To address the recommendations from the One Stop Planning of Services for Young Children and
their Families through Multi-use Community Sites report by conducting a situational assessment
related to positive parenting education in Waterloo Region as well as gauging the interest in the
development of a comprehensive, community-wide approach to parenting programs and supports
that is evidence and practice-based.
This project is connected to the Region of Waterloo Strategic Plan 2011-2014, Focus Area of Healthy and Inclusive
Communities and specifically works towards addressing the following Regional goal:
4.6 Collaboration with the community to support the development of services for children.
1.3 Methodology
The project is divided into two phases, with the first phase concentrating on defining the issue, conducting the
situational assessment, confirmation of the results, and creation of recommendations. In the second phase, which
has not yet been initiated, a plan for implementing the recommendations will be developed. Table 1 provides an
overview of this process.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
11
Table 1 Overview of project phases
Phase 1:
• Define issue
December 2010• Conduct situational assessment including the following components:
March 2012
o Literature Review
o Environmental scan including community inventory and survey, gaps analysis,
best practices identification
o Identification of priority populations
• Reporting and discussion
o Creation of technical report and final report
o Dissemination of results
o Generation of suggested actions and recommendations
o Approval of recommendations
Phase 2:
• Communication plan of findings and approved recommendations
March 2012 – March • Creation of an implementation plan
2013
An advisory committee made up of staff from ROWPH provided guidance at all steps throughout the project.
The methodology for each stage of the process is described briefly in the respective sections of this report.
1.4 Research questions
The following question provided a starting point for this inquiry:
•
Within the context of the OPHS requirements, what is Region of Waterloo Public Health’s role in a
comprehensive positive parenting approach in Waterloo Region for parents of children prenatal to 18 years?
To respond to the main research question, it was identified that responses to the following eight research questions
were needed to fully understand the best way for ROWPH to proceed and how that might be implemented:
1. What does evidence suggest are the best practices for a community-wide, comprehensive approach to
positive parenting?
2. Which priority populations are identified in evidence for a comprehensive positive parenting approach?
3. What are other Public Health Units (PHU) across Ontario doing to meet the OPHS for positive parenting?
4. What positive parenting strategies currently exist in our community for parents of children prenatal to 18
years?
5. Are there gaps in the positive parenting strategies that exist in our community in terms of covering all of the
elements suggested in an evidence-based, comprehensive positive parenting approach?
6. Are there gaps in the positive parenting strategies that exist in our community, as related specifically to
addressing the needs of priority populations?
7. Is there community interest in working together towards a community-wide, comprehensive positive
parenting approach?
8. Within the context of the OPHS requirements, what role can Public Health play in addressing the gaps that
exist in our community to fulfilling a comprehensive positive parenting approach?
Each research question contained various sub-questions that provided more detail towards responding to each area
of inquiry. The Research Methods and Questions Diagram outlines how all of the research questions and sub-
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
12
questions flow into each other (See Appendix B). The diagram also indicates the sources of information used to
respond to the research questions.
2.0 Literature Review
2.1 Literature Review Process
The purpose of the literature review was to respond to the following nine questions in regards to positive parenting:
1.
2.
3.
4.
5.
6.
How is positive parenting defined in the literature?
Why is positive parenting important?
What is a positive parenting strategy?
What are the key components in effective positive parenting strategies?
What is a comprehensive approach to positive parenting?
Are there strategies in the literature that fulfill the definition of an evidence-based, comprehensive approach
to positive parenting?
7. What does the literature say about other parenting strategies?
8. Who are the priority populations for a positive parenting strategy?
9. What other issues need to be considered?
Over 300 resources were reviewed and resulted in the inclusion of 212 resources comprised of academic, peerreviewed sources as well as resources from grey literature (e.g. internet, content experts).
2.2 Literature Review Summary i
How is positive parenting defined in the literature?
The majority of articles and resources reviewed used the term ‘positive parenting’; but very few actually defined the
phrase. Positive parenting strategies seem to refer to parenting strategies that nurture the child’s individuality, and
promote a close, warm relationship between the parent and child, while setting up and maintaining appropriate
boundaries for the child with both positive and non-punitive consequences for behaviour. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
14,15,
Invest in Kids (2010) provides a succinct and explicit definition of positive parenting (See Figure 1).
i Note: Due to the large volume of research reviewed, some statements are not referenced comprehensively; but, are referenced with a few resources which
support the statement.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
13
Figure 1 Invest in Kids' positive parenting definition
A ‘positive parent’ is a loving, understanding, reasonable and protective teacher and model.
A positive parent is loving when he or she:
 Is warm and nurturing, showing unconditional love
 Listens for and responds sensitively to each child’s needs
 Has empathy with and respect for each child
A positive parent is understanding when he or she:
 Understands each child’s temperament and works with it
 Builds on the strengths of each child
 Is flexible with each child
A positive parent is reasonable when he or she:
 Is consistent and predictable
 Sets and communicates clear limits and expectations
 Constructs consequences for irresponsible behaviour that are natural and reasonable, but not punitive
A positive parent is protective when he or she:
 Is actively involved with each child
 Provides a physically and emotionally safe environment for each child
A positive parent is a teacher when he or she:
 Provides opportunities to learn in an atmosphere of acceptance, encouragement and expectations of success
 2.0
Offers choices and encourages problem solving and decision-making
Figure
A positive parent is a model when he or she:
 Models appropriate behaviour
 Knows herself or himself
Reprinted/Adapted with the permission of © 2011 Parents2Parents www.parents2parents.ca and hosted by The Phoenix Centre www.phoenixctr.com. All Rights
Reserved. (Invest in Kids, 2010). 16
McTaggart and Sanders (2007) define positive parenting in 17 core child management strategies, including 10
strategies that promote positive behaviours in children, such as spending quality time, talking with children, showing
physical affection, praise, and attention, etc., and seven strategies for managing children’s misbehaviours, such as
setting rules, using planned ignoring, quiet time and time out (9). 17
Sanders et al. (2009) describe the “five core principles of positive parenting” as:
1.
2.
3.
4.
5.
Ensuring a safe, interesting environment
Creating a positive learning environment
Using assertive discipline
Having realistic expectations
Taking care of oneself as a parent (5). 18
For parents of adolescents, the emphasis on the importance of the relationship between the parent and the child
remains consistent in describing positive parenting; however, there is less focus on the parent being warm and
praising. Instead, behaviours which encourage children’s uniqueness while providing them with necessary
boundaries14, 19, 20, and monitoring youth behaviour are highlighted. 11, 21,22, 23,
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
14
The following definition of positive parenting is found in OPHS:
Positive/warm and consistent parenting interactions with the child [i.e.] parents frequently talking,
playing, praising, laughing and doing special things together with their children, clear and
consistent expectations and non-punitive consequences with regard to child behaviour (19). 24
Authoritative parenting style, frequently described in the literature, is related to the definition of a positive parent. An
authoritative parent is described as warm and responsive while firm in setting boundaries for their children. 25,26,27, 28,
29, 30, 31, 32, 33, 34
Attachment-based interventions were also the focus of many resources reviewed, and are comparable to concepts of
positive parenting. Both attachment-based interventions and positive parenting encourage the development of a bond
between the parent and child and the adoption of a child-centered approach. 35
Why is positive parenting important?
“…one crucial element in healthy child development is high quality parenting” (12). 36
Parents play a significant role in their children’s development and can provide protective factors against
adversities. 37, 38, 39 The relationship that a child has with their primary caregiver greatly shapes a child’s identity and
sense of security. A supportive and nurturing caregiver will encourage the child’s uniqueness and build on their
strengths, can protect the child from feeling the effects of growing up in a higher risk environment, can shield them
from experiencing the stresses of living in poverty, and can help them to build resiliency.9,10 ,40 A child with a warm
and loving caregiver will experience the world around them as safe and they will feel more confident in exploring their
environment.
In the first six years of life, the primary caregiver(s) has the greatest impact on the child’s development. This is
determined by the caregiver’s responsiveness to the child’s needs, how and when stimulation is provided, and the
degree to which there is a safe and nurturing environment.38, 39, 41, 42 Children’s exposure to high levels of stress
during the time that the brain is developing can have damaging effects on the brain which subsequently affects all
other areas of development.38, 39, 43 Brain scans of children have shown that growing up in an extremely neglectful
environment will alter the child’s brain physically. 44
In the teen years, the role of the parent shifts, though their impact remains significant. 45 Parents play a major role in
helping youth to build resiliency, to make safe choices, and to develop their sense of self.31 However, harsh parenting
during the teen years can have the opposite effect, lowering resiliency and increasing the likelihood of exposure to
adverse situations.23, 46, 47 Poor parental engagement in the lives of their teen children, or failure to monitor their
child’s behaviour, can have a major impact on youth participating in risky behaviours.11, 48, 49, 50, 51 Dittus et al. (2004)
highlights recent studies that have shown that adolescents who perceive that their parents are not monitoring their
behaviour are more likely to become involved in “several adolescent health risk behaviours, including sexual risk
behaviour, substance use, drug trafficking, school truancy, and violence”(8).11 Parenting interventions can be
effective in preventing and reducing specific risky behaviours with youth, such as alcohol consumption, smoking
and/or drug use, suicide, and introduction to sexual activity, as well as promoting healthier lifestyles or emphasizing
harm reduction.11,32,33, 48, 52, 53, 54,
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
15
Parenting interventions that reach out to all parents and normalize seeking support in the parenting role can be highly
beneficial for the health of the whole population.9,12, 55, 56 All parents may need some amount of support in raising
their children; however, some parents may require more support, particularly those individuals whose upbringing has
less prepared them to support their own children’s development and growth. Cowen (2001) identifies that “a lack of
knowledge about child development and inadequate parenting skills are contributing factors to the risk of child
maltreatment” (73). 57 Similarly, Petra and Kohl (2010) suggest that parents who lack the knowledge and skill to deal
effectively with child behavioural problems are more likely to resort to harsh parenting or maltreatment. 58 Children
who experience poor parenting are four times more likely to be at risk for clinically significant emotional and
behavioural problems than children who experience good quality parenting (429). 59, 60, 61 The research clearly shows
that risk factors for negative outcomes for children can occur within all household income levels, although, growing
up in a lower income household is associated with higher prevalence of risk.39, 40, 60, 62, 63 Importantly, Belsky (2005)
found that the factors that impact parenting practices are varied, complex, and very much interrelated.20 These
factors include: the child’s attributes, the developmental history of the parents and their own psychological make-up,
and the broader social context in which parents and this relationship are embedded.20
Parenting has a significant impact on children’s emotional and behavioural development.13, 64, 65 Halweg et al. (2010)
report that “approximately 20 per cent of children in western industrialized countries experience the signs and
symptoms that constitute internalizing (e.g. anxiety/depression, withdrawal) and externalizing (e.g. oppositional
defiance, aggression) DSM-IVii disorders” (1). 66 The National Longitudinal Survey of Children and Youth estimates
that “nearly 30 per cent of Canadian young children have an identifiable cognitive or behavioural problem that leaves
them vulnerable to a life of compromise” (12).36 The literature shows a clear link between positive parenting practices
and reductions in child conduct disorders iii, which can lead to positive outcomes for children later in life.40, 60, 64, 65, 67, 68
Stemmler et al. (2007) suggest that “while positive parenting is more closely related to the child’s prosocial
behaviour, inconsistent discipline is more closely related to the child’s problem behaviour” (568).34 Bosmans et al.
(2006) advise that research shows that the following parenting practices relate to behavioural problems:
•
•
•
•
•
•
Punitive discipline (yelling, nagging, threatening)
Inconsistent discipline
Lack of warmth and positive involvement
Physical aggression (hitting, beating)
Insufficient monitoring
Ineffective problem-solving modeling (374).14
Furthermore, maladaptive or harsh parenting practices have been linked to long term effects of increased risk of
aggression, the development of conduct disorders, and a variety of negative consequences for children and youth as
they grow up, including delinquency, higher drop out rates, and substance use: 18 55, 60, 69, 70, 71, 72, 73, 74, 75, 76
Ineffective and harsh parenting has been linked to child maltreatment and a variety of other
undesirable outcomes and constitutes an important public health problem (493). 77
Positive parenting strategies have been shown to have a significant impact in reducing conduct disorders for a
diverse array of families:15, 17 71, “Parenting programmes based on social learning principles have been repeatedly
ii
DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
iii
National Institute for Health and Clinical Excellence define conduct disorders (2006) as “Conduct disorders are characterized by a repetitive and persistent
pattern of antisocial, aggressive or defiant conduct” (5).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
16
shown to be effective in reducing conduct problems in children and producing lasting positive change” (768).65
Moreover, Gardner et al. (2010) found that “parenting programs can be as effective, or even more so, with the most
disadvantaged and distressed families” (578). 78
Consistently, parental stress is connected to factors related to increased risk of conduct disorders for children, and
parenting interventions have shown to have positive impacts on parents’ emotional well-being.69 Parents
experiencing stress tend to resort more often to harsh parenting practices, which have been shown to increase
children’s behaviour problems. 20, 79, 80 Parent training programs have the impact of increasing parental competence,
which in turns lowers their stress, affecting their emotional well-being.47, 81, 82, 83, 84, 85, 86
The research also examined the importance of providing parents with information related to child developmental
stages, but found that they were not as effective as parenting strategies that were based on behavioural outcomes of
children. 81, 87 While providing information on children’s development is important for parents to anticipate the needs
of their children, in terms of affecting childhood outcomes, teaching parents specific skills or enhancing their selfefficacy in parenting, seemed to be more beneficial.
A number of studies made the case for preventative parenting strategies as being financially beneficial in reducing
the costs associated with treating or supporting individuals with severe clinical disorders later in life.68, 71, 77, 88, 89
The literature shows that investing in preventative interventions earlier on can reduce the rate of child
maltreatment as well as redirect the path of a child experiencing higher risks for problematic behaviour including
delinquency and drug abuse, ultimately resulting in societal cost-savings in a variety of areas including child
protection services, enforcement, judicial system, unemployment, health care, mental health services, loss of
productivity, and hospital costs. 63, 71, 77, 88, 89, 90
What is a positive parenting strategy?
Positive parenting interventions are created on the belief that parents are responsible for providing children with
home conditions that promote optimal development. These conditions include providing a safe learning environment,
using positive reinforcement to support the development of appropriate behaviours, and reducing exposure to risks
by setting appropriate boundaries.11, 14, 73 Skills that are taught in positive parenting interventions focus on enhancing
parenting skills and the relationship between parent and child as a way to address children’s developmental,
emotional or behavioural difficulties.42 Positive parenting strategies also include a focus on non-punitive
consequences for behaviour. This means that praise and rewards are used to foster positive behaviour, and nonviolent alternatives to punishment are highlighted for negative behaviour.18, 91, 92, 93 This could include redirecting,
ignoring, reasoning, and utilizing natural consequences. It also includes seeking to understand the reasons behind
the child’s behaviour so that an appropriate response can be used.35, 94
Positive parenting strategies pull from the social learning theory model of parent-child interaction where positive
attention from the parent, rewards, or time with the parent encourages a child to adopt positive behaviours. In
contrast, “parents can also inadvertently encourage negative behaviours such as non-compliance or aggression by
rewarding it with attention or attempts to negotiate with a child” (139). 95 Therefore, interventions to address behaviour
concerns are aimed at the parent. 96 As Mann (2008) suggests, “parent outcomes are a mediating variable for
achieving child outcomes” (3). 97 Interventions based in social learning theory emphasize the importance of modeling
the behaviours that you would like repeated, providing parents the opportunity to practice what they have learned,
and using reinforcement to encourage self-efficacy.11, 56, 90, 91 Positive parenting strategies may also include
components that address concerns related to caregiver mental health, which affects their ability to fulfill their role as a
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
17
parent or caregiver. 98 These strategies can take different forms, e.g. from mass media campaigns or large group
parent workshops to one-on-one intensive work with a family.18
Most positive parenting interventions discussed in the literature were parent training programs that promote positive
parenting approaches, some of which were interventions for specific populations and some of which were available to
the general population. Positive parenting policy interventions were described in a few articles. Recommendation 19
on “Policy to Support Positive Parenting” was adopted by the Committee of Ministers of the Council of Europe in
2006 and endorses the importance of children growing up in a positive family environment and recommends that it is
the “responsibility of the state to create the right conditions for positive parenting” (282). 99 As explained by Rodrigo
(2011) Recommendation 19 addresses the social conditions which can impact parenting practices:“Creating the right
conditions also means taking steps to remove barriers to positive parenting, such as policies to promote a better
reconciliation of family and working life, and importantly, raising awareness of the value of positive parenting”(283).99
The provincial government of Manitoba enacted the Healthy Child Manitoba Strategy, a child-centered public policy,
which requires analysis of governmental decisions with the lens of the impact for children and youth and how they
can support the optimum growth and development of children, especially in the early years. 100 Other articles identified
the importance of political and infrastructure support to implement population-based strategies 101 with specific
emphasis on the need to de-stigmatize participation in parenting strategies and raise awareness of the importance of
the parenting role.55, 102
What are the key components in effective positive parenting strategies?
Many positive parenting interventions have not been thoroughly evaluated; thus, this review of the effectiveness of
positive parenting interventions has some limitations. There were two major concerns with the evaluations reviewed:
lack of rigor with regard to the methodology chosen, i.e., no randomized control trial (RCT), or lack of evaluation of a
strategy, i.e. sole evaluation of a strategy. Other concerns with the evaluations of positive parenting strategies
include small sample sizes, lack of control group and lack of research examining the long-term outcomes related to
the strategy. While large sample RCTs are considered the ‘gold standard’ of research studies, there is still much that
can be learned from practice-based knowledge. Mazzucchelli and Sanders (2010) affirm “most practitioners deliver
interventions comprised of an eclectic mixture of goals and methods that therapists have fashioned from their own
previous training, supervision, and clinical experience” (238).4 McLennan and Lavis (2006) support this claim
suggesting that there is a “research-practice gap” in terms of parenting interventions offered in the community
(454). 103 Turner and Sanders (2006) add that many parenting interventions have not been evaluated, and those that
are considered evidence-based are not widely available; thus, it is important to learn from what interventions are in
the community as well as from research.9 Furthermore, a pitfall of a clinical trial of a strategy is that it does not offer
information about how the strategy can be effectively implemented in a ‘real-world’ setting.72, 88, 104 The following
information from the peer-reviewed articles and the grey literature resources offer some insights into the components
of a positive parenting strategy that increase the likelihood of positive outcomes for children and parents.
The literature review did not produce much evidence specifically referred to as ‘best practices’ for positive parenting
interventions. However, one study stated that “intervention approaches that build on family strengths, are
developmentally appropriate, and emphasize strengthening parent-professional collaboration are considered best
practices” (quoted in McIntyre, L.L., 2008, 1189). 105 Golding (2007) outlines the guidelines for parent education or
training as set out by the United Kingdom’s National Institute for Health and Clinical Excellence, which state that a
successful program should:
•
“Be structured based upon a Social Learning Theory curriculum;
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
18
•
•
•
•
•
•
•
Include relationship enhancing strategies;
Offer an optimum of eight to 12 sessions;
Enable parents to identify their own parenting objectives;
Promote generalization to home through the use of in-session practice using role play and
homework between sessions;
Be delivered by appropriately trained and skilled facilitators who are able to engage in a productive
therapeutic alliance with the parents. These facilitators should be supported with appropriate
supervision and continuing professional development;
Maintain fidelity to the programme manual; and
Support the participation of parents who might find it difficult to access the programme” (40).41, 68
Not surprisingly from the vast research on the importance of early intervention, preventative interventions as opposed
to reactive interventions seem to be more effective.9, 106 The World Health Organization recommends that the “most
effective way of addressing child protection needs is through programmes of prevention, particularly at primary level”
(527). 107
Different mediators were found to influence the effectiveness of positive parenting interventions, with the following
components considered important to include in an intervention: education on a broad range of skills, content related
to behavioural strategies, role-playing practice, promotion of parental self-efficacy iv, and fit between parents’ needs
and program content.17, 18, 73, 87, 104, 106 McTaggart and Sanders (2007) found that “parenting programmes that are
effective will be those that target improving a parent’s sense of self-efficacy and satisfaction rather than providing an
isolated set of management strategies” (14).17 To this end, including direct practice or role-playing in an intervention
is an important method of teaching because it allows the facilitator to give the parents immediate feedback that can
help to reinforce their parenting competence. Kaminski et al. (2008) found that parenting programs that included
opportunities for parents to participate in direct practice with their child had higher effect sizes than those that did not,
regardless of the content of the program.87 Barth (2009) adds that “a CDC v review of parent training programs found
that parents who are given hands-on practice using new skills under the watchful eye of a professional acquire the
skills more effectively” (109).82 Although not specific to positive parenting interventions, Tully (2009) also suggests
that the following intervention components are “associated with large effects in parenting skills and/or child
behaviours and adjustment:
•
•
•
•
Teaching parents skills related to emotional communication
Teaching parents to interact positively with the child
Teaching parents to use ‘time out’ strategy and to discipline consistently
In vivo practice with the child during the program” (7).81
Both the length and the intensity of positive parenting strategies were examined in the literature; however, there was
no agreement on the effectiveness of brief intervention (generally five or less sessions) versus longer-term
interventions. The general belief is that there is a dose-response effect, in that the longer a parent participated in a
program, the more likely they would experience positive outcomes as a result. Some studies did find this effect to be
true.69, 89, 108, 109 Dumas et al. (2011) found that parents with higher attendance increased their positive parenting
iv
Self-efficacy = “one’s belief in the ability to successfully perform the behaviour necessary to achieve a desired outcome” (614).111
v
CDC = Centers for Disease Control and Prevention
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
19
practices and saw more positive outcomes for their children. They also decreased their harsh parenting practices and
saw less challenging behaviours with their children.108 Similarly, Scott et al. (2010) found that parents who attended
more sessions had greater changes on both observational and self-report measures of positive parenting.89
However, findings from a few studies revealed some evidence to support that brief parenting interventions can
increase parents’ adaptation of positive parenting strategies and can result in positive outcomes for child
behaviours.51, 13, 18, 86, 110, 111 Bakermans-Kranenburg et al. (2003) found that fewer contacts (<5 or 5-16 sessions)
were more effective than longer-term interventions (16 sessions or more) for increasing maternal sensitivity in
attachment-based interventions. 112 Lim et al. (2005) found that even a brief two-hour intervention could motivate
parents to use more positive parenting practice; however, families who experience chaotic family lives, or multiple
risk factors, may need a more intensive intervention.51
When comparing the effectiveness of individual versus group interventions, there were mixed results with both types
of intervention being important for different situations.15, 81, 84 In a meta-analysis of studies of Triple P- Positive
Parenting Program (See Appendix C for the full description of the levels of Triple P), Nowak and Heinrich (2008)
suggest that since there is a “lack of consistent impact of group, self-administered or individual session format” on the
outcomes they measured, “all three formats may be equally effective” (135). 113 The research seems to indicate that
individual interventions may be more effective for more severe, complex disorders, whereas group interventions are
more cost-effective and can have an impact on mild to moderate behavioural or emotional problems, even for those
children whose disorder falls within a clinical range.41, 68, 83, 114 In their meta-analysis of 63 peer-reviewed studies,
Lundahl, Risser and Lovejoy (2006) found that individual parent training programs were more appropriate for families
who are economically disadvantaged than group-based approaches. Individually based parenting interventions allow
for a more tailored approach to working through families’ specific concerns. However, Lundahl et al. (2006) caution
that families who are economically disadvantaged tend to have less social supports and may benefit from the group
experience; thus, parent interventions may need to combine both delivery methods.15
A public health approach suggests that both universal and targeted approaches are necessary in order to improve
the lives of the whole population. The literature suggests universal approaches can be effective in having an impact
on childhood outcomes but that targeted approaches are still important to meet the needs of the most vulnerable
children and families.34, 88 For example, Nowak and Heinrich (2008) found in their meta-analysis of Triple P studies
that the levels of Triple P which correspond to a more targeted focus tend to produce better outcomes than more
universal levels.113 Scott et al. (2010) suggests that in order to be more cost-effective interventions should focus
more on clinically defined behavioural problems.89 However, in a study that examined population level effects of a
comprehensive approach to positive parenting, Sanders et al. (2008) found that “a coordinated across agency
system of parenting support can produce meaningful population level effects” (217).60 Evaluations of the Media
Triple-P program, also known as Universal Triple P, which is level 1 of Triple P, demonstrated that a low intensity,
public health population approach could be effective in reducing mild child behavioural problems.75 To bring both
approaches together, Barlow et al. (2010) suggest that interventions could use “a model of progressive universalism
in which universal services are used to identify families in need of more specialist progressive intervention” (179).43
More and more the focus of public health approaches to parenting interventions is on how technology can be used to
help engage more parents. As Sanders and Prinz (2008) suggest, relatively few parents actually participate in
evidence-based parenting interventions, and parents from socially disadvantaged families, families who tend to be at
higher risk, have even lower participation rates.75 Universal approaches aim to increase participation rates in
interventions to reach more of the population and the use of mass media is one method to facilitate the delivery of
parenting messages to a wider audience.64, 75, 81 Tully (2009) suggests that self-directed approaches or media-based
approaches are useful because they have less barriers to participation, less stigma, and fewer costs.81 Sanders, and
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
20
Calam, et al. (2008) examined how a parenting intervention method using a television series, self-directed workbook
and web support could be used to reach more families and reduce barriers associated with participation. Although
this study had some limitations, as it relied on self-reports with no control group, they did find significant
improvements in children’s behaviours and positive parenting practices.5 Sanders and Prinz (2008) evaluation of a
Triple P population-wide, mass media campaign using an ‘infotainment’ television show, found positive parenting and
behavioural outcomes for both the participating and viewing families.75 Cefai, Smith and Pushak (2010) found that a
self-administered CD-ROM version of their positive parenting programs with teens, Parenting Wisely, was as
effective as the group method in increasing parenting competence and improving child behaviour. Furthermore, the
outcomes from the self-administered program were maintained after three months whereas the outcomes for groupformat participants were not.86 Media-based interventions can be especially useful for parents and youth living in rural
communities, both in terms of outcomes and program uptake. 115
Some articles reviewed the effectiveness of strategies for specific target populations. Barth (2009) suggests that
“stepped care interventions that fit the unique characteristics of the clients rather than the vision of the treatment
designer” are most beneficial (106).82 For example, in a meta-analysis of interventions that work towards reducing
stress for parents of children with developmental disabilities and decreasing children’s behaviour problems, Singer,
Ethridge and Aldana (2007) found that “when more complex intervention methods were presented to parents over a
relatively longer period of time than in the single component studies, there were substantial reductions in parental
distress” (367). 116 Many of the strategies employed for targeted populations have been successfully adapted from
universal approaches to meet the needs of the target population. A study of an adaptation of the Incredible Years
Parent Training program (Incredible Years) vi showed that it could effectively reduce behavioural problems for children
with mild to moderate developmental delays.105 The Stepping Stones Triple P program, a specialized version of Triple
P for children with a disability, was shown to improve parental reports of child behaviour and positive parenting
practices for parents of higher functioning children with Autism Spectrum Disorder (ASD). 117
Overall, the literature indicates the importance of a multi-pronged approach to positive parenting.20, 43, 64, 104 The
literature on public health approaches strongly suggests that parenting interventions that are based on a
comprehensive approach can have the greatest impact on families as they reach out to and meet the needs of more
individuals than a single parenting intervention.42, 60, 63, 73, 77
What is a comprehensive approach to positive parenting?
For the purpose of this project, a comprehensive approach is defined as an approach that encompasses different
levels of intervention, including prevention, that provide both targeted interventions as well as population-based
strategies based on the needs of the community, and involve various service providers offering multiple access
points for families.
A comprehensive approach takes into account different levels of needs in the community as well as the different
methods that may work best for delivering the interventions that meet these needs. The literature describes effective
delivery methods that range from universal marketing campaigns to intensive one-on-one tailored interventions.
Many articles also suggest that a comprehensive approach needs to combine several health promotion strategies to
reach a wide audience. The Ottawa Charter, a significant document in international public health practice, suggests
that the key actions to develop a comprehensive health promotion approach are:
vi
See Figure 2 on pg 24 for more description of Incredible Years
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
21
•
•
•
•
•
Build healthy public policy;
Create supportive environments;
Strengthen community action;
Develop personal skills; and
Reorient health services (3-4).118
Tully (2009) further suggests that there are three essential levels that parenting programs need to cover. Similar to
the different levels of prevention, they include:
•
•
•
Universal parenting interventions with the purpose of strengthening protective factors or prevention of
problems;
Selective parenting interventions with the aim of reaching families at higher risk for developing problems;
and
Indicated parenting interventions with the aim of reaching families who are already experiencing problems.81
To meet each of these levels of needs, a comprehensive approach needs to include tiered levels of supports. This
means that the supports available to families are coordinated so that service providers can direct families easily
through the different services. It also means that the different supports available to families increase in intensity, e.g.,
from a one-time large group seminar to a one-on-one individualized treatment plan. This enables service providers to
direct families to supports that are most appropriate for their level of need; and should they require further support, to
refer them on to a more intense level. This aspect of a comprehensive approach works on the principle of providing
families with only the necessary level of support and beginning with the least intrusive level of support. Because
individuals with different levels of needs will most likely connect with service providers through different avenues,
other key components to a comprehensive approach are the coordination of services, the involvement of different
community organizations or access points, and the involvement of different disciplines.43, 55, 68, 73, 82
Other synonyms found that describe a system that was comprehensive include a ‘multi-faceted approach’,
‘population-based approach’ or ‘ecological’ approach.9, 55, 63, 13, 82, 6, 106 Sanders and Prinz (2008) propose that “a
population approach to parenting intervention, unlike a clinical high-risk approach, by necessity involves the use of
multiple settings, disciplines, and service delivery modalities” (130).55 A population-based approach refers to
considering the needs of all people within the population; thus, designing interventions that cover both universal and
targeted approaches, and including different methods to reach as many people as possible. An ecological approach
refers more to considering the person’s whole environment when designing an intervention, which may only cover
some aspects of a comprehensive approach. Moreover, the term comprehensive was often employed throughout the
literature referring to the breadth of skills or topic areas covered by the program. 119 This definition of comprehensive
approach does not align with the selected definition for this project, as it does not cover all of the key components.
The literature clearly indicates that a comprehensive approach to positive parenting can have significant impact at a
population level.77, 6, 107 Shapiro et al. (2010) affirm that “unless evidence-based programs are deployed by a wide
range of providers and used by a significant portion of the population, the impact on the population will remain quite
limited because relatively few parents are exposed to the intervention” (224).101 Furthermore, integrating both
targeted and universal strategies into a population-based positive parenting approach creates an atmosphere of
acceptance for parenting interventions and contributes to a healthier environment for all children.12 Similarly, Prinz et
al. (2009) support that:
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
22
Reducing the prevalence of coercive parenting in the community requires that a large proportion of
the population be reached with effective parenting strategies… Thus, a key assumption of a
population-based approach is that parenting intervention strategies should be more widely
accessible in the community. To achieve this aspiration, a variety of formats, delivery modalities,
provider disciplines, and access points need to be invoked (2).63
Are there strategies in the literature that fulfill the definition of an evidence-based, comprehensive approach
to positive parenting?
Two strategies were identified in the literature as evidence-based, comprehensive approaches to positive parenting
strategies; they are Triple P and Incredible Years. Both of these strategies were recognized as best practices in the
Canadian Best Practices Portal search; see Appendix D. They also yielded the highest volume of research studies
conducted. The United Kingdom’s National Institute for Health and Clinical Excellence (2006) state that these two
programs contain the essential characteristics necessary for an effective parenting program to manage child conduct
disorders, and are both deemed cost-effective.68
Triple P is a strategy available for purchase that emphasizes the need to inspire parents to gain more confidence in
their parenting skills and become independent problem solvers. 120 The program incorporates 17 core child
management skills, which promote positive behaviours and development, and provide parents with skills to deal with
behaviour management.121 Prinz et al. (2009) assert that “one of the few examples of a public health approach to
parenting is the Triple P system” (2).63 Triple P is comprehensive because it has five levels of coordinated
interventions based on the intensity of needs ranging from universal to specific targeted interventions; it provides
different delivery methods; it spans across the age range from prenatal to 16; and it includes practitioners from many
disciplines and different access points in the community.12 60 Bodenmann et al. (2008) suggest that the tiered
multilevel strategy of Triple P “recognizes that parents have different needs and desires regarding the type, intensity
and mode of assistance they may require” (415) 121. Triple P “involves identifying the minimally sufficient conditions
that need to change in order to alter children’s risk developmental trajectories for developing serious conduct
disorders” and providing the family with the appropriate level of intervention to fit those needs (984).64 Triple P has
also been adapted to meet the needs of families of children with different abilities, and from various cultures.56, 73
Evaluations of Triple P show that it is effective in increasing positive parenting practices, decreasing harsh parenting
practices, and reducing child behaviour problems and parental mental health concerns. It has been shown to be
effective for a variety of populations including: parents from different socio-economic backgrounds and family
circumstances; parents involved in children’s protective services; parents of different cultural groups; parents of
children with different abilities; and parents of children of different age groups.9, 58, 60, 63, 82, 83, 91, 92, 95, 117, 120, 122, 123 In a
meta-analysis of effectiveness of Triple P, Nowak and Heinrich (2008) found that “the evidence-base for Triple P
confirms the efficacy of the intervention for improving parenting skills, child problem behaviour and parental wellbeing” (138).113 Sanders, Bor and Morawska (2007) evaluated three different variants of Triple P and found that
“maintenance of treatment gains and the changes observed in levels of disruptive behaviour had either maintained or
shown further improvement by 3 year follow-up” (995).64 In addition, Prinz et al. (2009) found that Triple P is capable
of having population level effects on parenting practices. They highlight that a U.S. Triple P trial was a “first study of
its kind…to randomize communities to condition, implement evidence-based parenting interventions as a prevention
strategy, and then demonstrate positive impact on population indicators of CM vii”(9).63 Furthermore, Mihalopoulos et
vii
CM= child maltreatment
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
23
al. (2007) found in economic analysis of Triple P that in comparison to the societal costs of conduct disorders, Triple
P “has the potential of saving more resources than it consumes” (243).74
Similar to the Triple P program, Incredible Years offers different levels of intervention to meet different parenting
needs. The Incredible Years includes three components: a parenting program for different age groups of children, a
teacher-training program and a child program. It also has different levels of intensity for the programs (See Figure 2).
The main goal is to promote children’s social competencies, emotional regulation, problem solving skills, and
reduction in behaviour problems.90
Figure 2 Incredible Years Program Model
THE INCREDIBLE YEARS is a registered trademark of The Incredible Years, Inc. All printed materials associated with THE INCREDIBLE YEARS program are
protected by copyright in the name of Carolyn Webster-Stratton d/b/a The Incredible Years all rights reserved. Reproduction of the materials or the production of
derivative works based on the materials is only allowed with the express written permission of the copyright holder. 90
The Incredible Years has been found to be effective in reducing child behavioural problems and in increasing positive
parenting practices for different populations.72, 124, 125, 126, 127 The intervention has been adapted to fit the needs of
families of children with different abilities and for families from different cultural backgrounds.78, 91, 93, 127,124 Gardner,
Burton and Klimes (2006) found that the Incredible Years could be adapted to a community-based setting and still be
effective in reducing observed conduct problems for children who experience higher levels of social disadvantage.72
Adaptations have also been made to the Incredible Years for parents who have been involved in the child welfare
system, which include increasing the number of sessions for these families as well as the amount of time spent on
behavioural practice.124 For example, although the sample size was quite small, an effectiveness trial of the
Incredible Years for foster caregivers was shown to be effective in reducing the children’s challenging behaviours as
well as the depression experienced by their foster caregivers.127 Furthermore, Scott et al. (2010) evaluated a
population-level prevention intervention, which combined the Incredible Years with a literacy program, and found that
it was successful in reducing four risk factors associated with antisocial behavioural disorders.88
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
24
Both Triple P and the Incredible Years are implemented in over 15 countries worldwide.18, 90
More research is warranted to look at the longer-term impact of each of these interventions.
What does the literature say about other parenting strategies?
Although the literature review focused on positive parenting strategies, many articles or resources referenced
parenting strategies that did not focus specifically on positive parenting but had similar goals or outcomes. There are
still lessons to be learned from these other parenting strategies, as many of these programs were highlighted in the
Canadian Best Practices Portal Search as an evidence-based parenting program; see Appendix D.
Sandler et al.’s (2011) review of 46 RCTs of different prevention-focused parenting interventions found that parenting
interventions can have a variety of positive outcomes for children and youth with lasting effects over time; although, it
is difficult to pin point which components of the program are the most effective.70
Even though it is not a comprehensive approach to positive parenting, the Nobody’s Perfect program is an evidencebased positive parenting intervention with positive outcomes for parents and children. The Nobody’s Perfect program
aims to increase parents’ knowledge and encourage positive parenting practices in regards to children’s health,
safety and behaviour, while improving parents’ confidence in their parenting, enhancing their coping skills, and
helping them to build greater support systems. 128 This program targets parents with children 0 to 6 years who are
young, single, socially, culturally or geographically isolated; who have low educational attainment; and who live with
low income.128 Evaluations of the program have been conducted and found positive outcomes for parents’ increased
knowledge and positive parenting practices; however, the majority use self- report data without control groups.108, 128
Chislett and Kennett (2007) found that attending the Nobody’s Perfect program increases parents’ confidence in their
parenting and their resourcefulness; however, this study did not have a control group.69 Skrypnek and Charchun
(2009) conducted a RCT of Nobody’s Perfect and found that the program was effective in increasing positive
discipline practices and reducing harsh parenting practices for those parents who participated in the program. These
changes were maintained over time.128
Although it was the focus of only one article, another parenting intervention that is evidence-based is the Family and
Schools Together (FAST) program. FAST is “an after-school, multi-family support group to increase parent
involvement in schools and improve children’s well-being” (McDonald et al., 2006, 26). 129 The main goals of the
program are to help parents and children build trusting social networks, to increase parents and children’s
engagement in the school system, and to decrease children’s aggression and increase their social skills.129 FAST has
been shown to positively impact children’s behaviour and school outcomes.129
The literature showed that interventions that encourage parents to raise their children from an authoritative parenting
style are effective in reducing harsh parenting practices and in improving the relationship between parent and child.27
28 An example of an authoritative parenting intervention is Parent-Child Interaction Therapy (PCIT). This intervention
is unique in that it combines play therapy with developmental and behavioural approaches, using live coaching to
parents from a professional behind a one-way mirror. Results indicate that this parenting intervention is effective in
increasing positive parenting practices, and reducing child behavioural problems and parental stress with different
groups of parents.28, 91, 96, 122 In one study, which compared PCIT to Triple P, Thomas and Zimmer-Gembeck (2007)
found that PCIT actually had higher effect sizes than Triple P on parent reports of child negative behaviours and
observed parent negative behaviours.96
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
25
Interventions that promote authoritative parenting styles seem to be especially effective with youth. They promote a
nurturing relationship between parent and child while maintaining firm boundaries, which are essential to teens as
they navigate testing out their independence.21 Various interventions, which looked at reducing youth risky
behaviours through parenting interventions, uniquely showed improved youth behaviours through increasing
authoritative parenting practices and encouraging better communication between parent and youth.32, 33 For
example, Kitzman-Ulrich et al. (2010) found that authoritative parenting practices had a positive impact on increasing
youth healthy behaviours related to physical activity and weight loss.33 Steinberg et al. (1991) also found that
authoritative parenting with youth could mitigate the impact of risk factors associated with ethnicity, socio-economic
status, and family structure. 130
Similar to interventions that promote authoritative style of parenting, the Bavolek Nurturing Program (BNP) promotes
democratic parenting, and proposes that change in the parent’s behaviour must occur before improvements in the
parent-child relationship can occur. The BNP program aimed to adapt the inappropriate expectations that parents
had for their children’s behaviour, increase knowledge of their children’s needs, and alter their beliefs in physical
punishment, through a combination of group-based setting and home visiting. Although there were several limitations
with the study, Cowen (2001) found that the BNP program was successful in increasing democratic parenting
practices for rural families at-risk of maltreating their children.57
Several resources focused on attachment-based strategies, which promote similar skill attainment as positive
parenting strategies in that they focus on strengthening the bond between parent and child, aiding in the
development of greater empathy and responsiveness to the child.14, 35, 131, 132 Attachment-based interventions tend to
focus only on the infant stage of development as this is the critical period for infants and their primary caregiver to
form a bond. Attachment theory proposes that the responsiveness and the bond between an infant and their primary
caregiver, usually focused on the mother, affect all areas of the child’s development, including sensory, cognitive,
and emotional development. Bosmans et al. (2006) found that attachment built in the early years was still a
significant factor influencing the relationship between parent and child, as well as the child’s behaviour, when the
child reached adolescence.14 They found that “the level of secure attachment plays an important role as the link
between parenting and problem behaviors” with youth (380).14 They say that parenting interventions in the teen years
are doomed to fail because shaping parenting styles has already lost its potential impact on youth behaviour.14 Doyle
et al. (2003) concur, suggesting that a secure attachment in infancy contributes to an adolescent’s ability to turn to
their parents for support and to have a “greater sense of mastery of their worlds” (i).45
A few of the attachment-based articles mentioned that a goal or objective of their intervention was to increase
positive parenting.35, 132, 133 Four of the attachment-based intervention studies looked at a specific method of training
parents in attachment-based theory, called the Video-feedback Intervention to promote Positive Parenting (VIPP).
The findings suggest that this program has positive effects on both mother and child outcomes.35, 111, 132, 133 This
intervention involves videotaping the interactions between mother and infant and then providing the mother with
feedback on how she can improve her interactions with her baby to promote positive development. The studies on
the VIPP intervention showed that it was effective in increasing maternal use of positive discipline and in decreasing
overactive child behaviours.35, 111, 132, 133 Bakermans-Kranenburg et al. (2003) meta-analysis of attachment-based
interventions found that “interventions with an exclusively behavioural focus on maternal sensitivity appear to be most
effective not only in enhancing maternal sensitivity, but also in promoting children’s attachment security” (212).112
Although the approach is not evaluated in the article, Simpson and Roehlkepartain (2003) describe the
Developmental Assets Framework, which suggests that the whole community can play a role in supporting positive
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
26
youth development. viii Simpson and Roehlkepartain (2003) propose that while parents are still the main influence in
the lives of youth, in order for parents to be more effective in their roles, they need a supportive environment
themselves. 134 The role of parents in the Developmental Assets Framework is similar to the role of parents in a
positive parenting approach. The following are the five basic ways parents contribute to healthy youth development:
1.
2.
3.
4.
Offering teens love and connection;
Monitoring teen behaviour and well-being;
Offering guidance, including negotiating and setting limits;
Providing information and consultation for understanding, interpreting, and navigating the
larger world, through a process of modeling and ongoing dialogue; and
5. Providing and advocating for resources, including other caring adults (167).134
Home visiting programs tend to focus on the early years, from prenatal to three years of age, and usually include
working on a wide range of family goals that support family functioning and early child development.10, 80, 135, 136
Although not all home visiting programs are created equal, a few home visiting programs, which may or may not
include components of positive parenting, seem to be the most effective for preventing child abuse.84, 122 Home
visiting programs address the multiple stressors and challenges associated with parents who maltreat their children,
which may be a contributing factor to their success as an intervention.10,137 Project SafeCare, a multi-faceted home
visiting program, which includes addressing parental, social and environmental factors, was found to be effective in
improving parenting skills, child health care skills, and safety of the home for children from families who have
maltreated their children.137 An evaluation of Healthy Families New York, a home visiting program that focuses on
working with women of children prenatally to three months to prevent child abuse, found that mothers who
participated in the program were more likely to engage in positive parenting practices than the control group.
Rodriguez et al. (2010) assert that the success of this home visiting program may be attributed to the strengthsbased approach taken by the home visitors, in which they reinforce the positive behaviours that the mothers already
exhibit and avoid providing any feedback on the negative behaviours.136 Evaluations of both the Nurse-Family
Partnership Program, a prenatal and infancy home visiting program for socially disadvantaged, first-time mothers,
and Early Head Start, a community-based support program for low income families with young children which
includes home visiting, have also shown to be effective in reducing child abuse and neglect.80, 135, 136 In fact,
MacMillan et al. (2009) found that the Nurse-Family Partnership program showed the best evidence for preventing
child physical abuse and neglect of all the home visiting programs they reviewed.122 MacMillan et al. (2009) describe
that there are three shared components between the Nurse-Family Partnership and the Early Head Start programs
that seem to contribute to their effectiveness, they include:
1. Developed as research programs
2. Delivered by highly qualified staff
3. Invested in ensuring the fidelity of program delivery.122
The literature review process included searching the Canadian Best Practices Portal, which summarizes
interventions that have been rigorously evaluated and have shown significant outcomes. See Appendix D for the list
of the positive parenting strategies and the other parenting strategies that were recognized on the Canadian Best
Practices Portal.
viii
Research studies have been conducted on the Developmental Assets Framework; however, none of these studies came up in this particular literature review.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
27
Who are the priority populations for a positive parenting strategy?
According to Sanders et al. (2007), “epidemiological research is needed to assist policymakers and service planners
to make informed decisions about who should receive evidence-based parenting interventions” (769).65 The literature
shows evidence of certain groups and developmental stages in which positive parenting interventions may have the
most impact at both an individual and a population level. The following section provides insights related to the
implementation of positive parenting strategies with specific populations including those related to specific age
periods when positive parenting practices may be critical. In addition, evidence is provided in relation to gender
differences as well as parent and family variables that may influence effectiveness.
Children in the early years
Offering positive parenting strategies in the early years provides the best opportunity to prevent the onset of conduct
disorders in children as well as other behavioural or emotional development difficulties.43, 66, 6, 94, 106, 112, 113, 133, 135, 136,
138, 139 Pinquart and Teubert (2010) suggest that prevention programs should begin prenatally as the transition period
into parenthood can be stressful; and reducing maternal stress and depression can lessen negative childhood
outcomes. 140 Rodriguez et al. (2010) suggest that beginning prenatally “they have a better chance to become part of
[a] mother[s’] habitual parenting practices” (712).136 Similarly, Hoffman (2011) adds that the transition to the
parenthood period is a critical time to engage fathers. 141 Also, Sanders, Bor, and Morawska (2007) found that parent
reports of emotional or behavioural problems increased with their children’s age, indicating that prevention of conduct
disorders should be targeted to younger children.65
Although early prevention interventions have been shown to be effective in reducing behavioural problems before
their onset, many studies point to the importance of developmentally appropriately timed interventions as being most
useful to meeting parents’ needs and engaging parents in the intervention.46, 60, 112, 140
Children in the pre-teen to teen years
Another age range that was identified as a critical time to intervene with parents is during the transition period
between middle school and high school, in the pre-teen to teen years.45, 31, 46, 23, 48, 50, 94 Contrary to what is often
portrayed in the media, evidence suggests that this is actually a time in a child’s life when they need their parents to
monitor them more and not less.50,142 For example, Kumpfer et al. (2010) highlight that research suggests that the
most significant protective factors against substance abuse for youth are parental monitoring, parents’
communication of positive family values, and a cohesive relationship between parent and child.104 The concern with
this transition period is that the part of the teen brain that is still developing during these years is the most important
part for regulating their decision making and impulse control.142 This is a time of high stress for parents as their
children are becoming more independent and testing their boundaries.23 Parents may also need support to develop
new discipline strategies for their youth, as strategies that worked in childhood mayl no longer be effective with teens.
This period often leads to parents feeling less confident in their abilities to monitor their children’s behaviour and to
set appropriate boundaries or expectations for their children.23 The literature shows that parents’ confidence and/or
stress level affects their ability to practice positive parenting. Moreover, positive parenting interventions can still be
effective with parents of teens.23, 47, 67, 122 Ralph and Sanders (2004) found that a teen positive parenting intervention,
Teen Triple P, showed increases in positive parenting practices for those who attended and “significant reductions of
targeted risk factors, with some evidence of improvements still being maintained at six-month follow-up” (5).23
Prevalence of conduct disorders also differ by gender in that boys are more likely than girls to experience behavioural
problems.65, 74, 94 However, this may be due to the fact that boys are more likely to externalize behaviours where as
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
28
girls are more likely to internalize behaviours; therefore, boys will experience more behavioural or conduct problems
and girls will experience more anxiety and depression.65
In addition to age and gender, many articles addressed different family or environmental risk factors for behavioural
problems and/or conduct disorders. They include: low income, lower parental education, single parenthood, teen
parenthood, witnessing or experiencing abuse or neglect, certain cultural beliefs or norms about parenting, maternal
stress or depression, or the challenges that a family may experience when a child is diagnosed with a specific
disorder, disability or as gifted or talented.65, 79, 80, 3, 6, 97, 133, 135, 143 For example, the National Center for Infant and
Early Childhood Health Policy in the U.S. found that the following groups of parents were identified as needing more
enhanced support and education around parenting practices:
•
•
•
•
•
Teen parents
Parents of children with special health care needs
Foster parents
Grandparents raising children
Fathers42
Children experiencing the effects of low income/poverty
Children who live in lower income households are at a higher risk of developing behaviour problems associated with
negative outcomes later in life.10, 82, 135,144 Coatsworth, Pantin and Szapocznik (2002) suggest that:
Economically disadvantaged neighbourhoods typically lack the physical and social resources that
help socialize children and adolescents toward health and well-being and instead tend to place
them at higher risk for most psychosocial problems including conduct disorders and substance
abuse (113).144
Parents who live with low income and have inadequate support in their environment tend to experience more stress,
which can lead to more social and emotional difficulties for their children.79, 80, 92, 138, 144, 145 Unger and Nelson (1991)
suggest that increasing social supports and altering social values around supporting families could greatly impact the
experience of parents and children growing up in low income.145 One study looked at the cumulative risk factors
encountered by parents who are homeless. These parents experience life stressors related to their immediate
situation, such as trying to provide the basic survival necessities for their children and stigmatization, and may
experience additional challenges related to lack of parenting role models, or histories of abuse or violence. 146 Swick
(2009) suggested that interventions that aim to support parents who are homeless should be provided by individuals
who are non-threatening and non-judgmental, and should include strategies to improve parenting skills in
combination with the provision of “essential social support resources”.146 Leung et al. (2006) found that parents from
socio-economically disadvantaged families reported greater changes resulting from participation in the Triple P
program, suggesting that engaging families from lower income in parenting programs is highly beneficial.92
Children experiencing or at risk for abuse or neglect
According to Letarte et al. (2010), approximately 10 out of 1000 children in Canada are either abused or neglected
every year. MacLeod and Nelson (2000) further propose that the rate of maltreatment is underreported in most
communities.63, 106, 125 Barth (2009) suggests that “researchers have identified four common co-occurring parental risk
factors – substance abuse, mental illness, domestic violence, and child conduct disorders – that lead to child
maltreatment” (95).82 Children who experience abuse or neglect, or who witness abuse of any kind, are at a higher
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
29
risk for developing emotional and behavioural difficulties that may lead to negative outcomes.41, 58, 60, 124, 125, 147
Children who experience abuse or neglect are also much more likely to maltreat their own children as adults.57, 97
Moreover, children in protective care tend “to have higher levels of behavioural problems compared to children in the
general population” (269). 148 For example, children’s experiences prior to moving into a foster home, difficulties in
establishing a trusting relationship with foster parents, or household stress related to caring for the needs of the child
may contribute to poor behavioural outcomes.127, 131, 149 Griffith’s et al. (2009) review of family characteristics of youth
in residential care found that youth at risk for developing conduct disorders tend to come from homes where
substance abuse, parent incarceration, marital problems, unemployment, neglect or abuse, and poor parenting skills
are present. 150 Parents of children who are in care require a supportive, non-judgmental environment in which to
participate in parenting interventions. They also have the added challenge of adapting positive parenting practices to
less ideal situations since they may not be able to practice what they learn in the parenting intervention with their own
child(ren). As such, specialized interventions may be required. However, more research needs to be conducted on
effective interventions for parents of children in care of child protection services to elaborate on this point.148
Children of parents dealing with depression or stress
Parental variables are often cited as risk factors for children’s development of conduct disorders: “High levels of
parental depression and stress are risk factors for the development of behavioural and emotional problems in
children and are predictors of coercive parenting” (781).65 Since maternal stress and depression impacts the
relationship between mother and child, they are noted in many articles as major contributors to children’s behavioural
development.43, 82, 97, 111, 140 It seems as though parental stress may be the mitigating variable that impacts parenting
practices for most, if not all, family types at higher risk for maladaptive parenting.10, 65, 15, 82 Other life stressors that
impact parents’ ability to provide a nurturing environment for their children include marital and work-related stress.98,
121 An evaluation of the Workplace Triple P program, a specialized program of Triple P, which is a group-based
parent-training intervention that aims to reduce stress resulting from an imbalance between work and life
responsibilities, was shown to increase participants’ positive parenting practices and lower work-related stress
overall.98 Family Transitions Triple P, another adjunctive support program of Triple P, addresses the conflict and
stress that children and parents can feel related to divorce.95
Positive involvement of fathers with their children is associated with healthy cognitive, emotional, social and physical
development of children and youth.141, 151, 152 Evidence suggests, however, that parenting interventions tend to have
smaller effect on behaviour changes for fathers, which may be in part due to lower participation rates of fathers.34, 121
More research is needed to examine how fathers can be better engaged and to determine if different strategies are
needed to do so effectively.113 Magill-Evans et al. (2006) found fathers’ participation in interventions, which led to
enhanced bonding between father and child, increased when interventions included direct observation or active
participation techniques. There remains, however, a lack of information about the impact of these interventions on
child development overall.152
Children of young/teen parents
Although parents who are teenagers were not explicitly highlighted as a priority population in the majority of the
research, young parents tend to experience multiple risk factors, often with a cumulative effect.97, 153 For example,
Slomski Long (2009) points out that “adolescent mothers have more limited educational and employment skills, lack
financial resources, endure high stress, and encounter more family discord compared to mature mothers” (1).143 She
further suggests that these risk factors can lead to a higher risk for developing a disorganized attachment with their
infant, which can lead to many negative outcomes for the child.143 Letourneau et al. (2007) describe that young
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
30
mothers are more prone to depression, experience more challenges, and have less social supports, often leading to
less optimal parenting practices. They also found that children of adolescent mothers show more anxiety and
hyperactivity than children of older mothers.153
Children of families living in rural communities
Parents of children living in rural communities may be at risk of using harsh parenting practices due to their isolation
and lack of access to parenting supports.6, 97, 115, 154 Lack of social supports can contribute to higher levels of stress,
which can lead to ineffective parenting practices.6, 154 Kosterman et al. (2001) suggest that youth living in rural areas
may be at an increased risk for health and behaviour problems, which may be associated with poor availability of
youth-based activities and services.48
Children of families that are new to Canada
A few articles discussed how cultural traditions might emphasize parenting practices that diverge from positive
parenting practices, such as those that promote corporal punishment. 80, 93, 126, 155 While not all individuals from a
cultural background will adhere to the same parenting practices, some cultural groups may be more likely to practice
harsh parenting due to cultural traditions. This may be further complicated by low program uptake by parents who are
new immigrants. Leung et al. (2006) found that new immigrant families were less likely to complete a parenting
program than non-immigrant families; thus, engagement and recruitment strategies need to be developed for these
parents.92 A possibility to consider is whether this is related to the initial lack of knowledge of parenting practices,
policies, or law in the new country for immigrants, which may change with experience and time in the new country.
Children with diagnosed disorders and/or special needs
A diagnosis or symptoms of a specific disorder or special need, such as Oppositional Deviant Disorder (ODD),
Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder (ASD), developmental delay or intellectual
disability, antisocial disorder or psychosocial disorder, increases the risk of behavioural or emotional problems.65, 88, 3,
97, 105, 117 Given that children with development delays or intellectual disabilities have an increased risk for developing
behavioural disorders and other problems, support to parents of these children is important. Increased likelihood of
parental stress and depression, further affecting a child’s behaviour, strengthens the case for being a priority for
positive parenting supports.2, 105, 116 Moreover, early intervention with children who have been diagnosed with an antisocial behaviour disorder, such as ODD, is important because it can help to prevent behavioural problems, known to
be associated with these anti-social disorders, from escalating and continuing into more severe delinquency as
adults.88
Children who are gifted or talented are also at risk for a higher prevalence of emotional or behavioural problems. This
may be associated with their parents’ decreased sense of confidence in being able to parent them effectively, and
higher parental expectations for what they believe their children should be able to accomplish.110, 156 One study on
the Gifted and Talented Triple P program, a specialized program of Triple P, found that while the program helped
parents to deal more effectively with their child’s behaviour, the content was not specific enough for gifted and
talented children.156 Although generalizability is limited due to the small sample size, this qualitative pilot study found
that parents wanted the intervention to focus on their child’s emotional and relationship issues, and to incorporate
coping strategies for the parents.156 More research is needed to determine the extent to which this Triple P program
can be effective with children with more severe clinical diagnoses.110
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
31
Limitations to identification of priority populations
A limitation to identifying priority populations in the literature is that the information is restricted by the articles that
were reviewed; thus, some priority populations may not have been explored. For example, members of the First
Nations community in Canada may be a priority population; however, there were no studies or articles in the literature
search that examined the needs or experience of First Nations people. Moreover, parents who identify as lesbian,
gay, transgender, bisexual, questioning, intersex, or asexual (LGTBQIA) were not included (or may have been
included in studies but were not discussed separately) in any of the studies which were reviewed. Thus, consultation
with other sources may need to be conducted in order to assess priority populations locally.
What other issues need to be considered?
Implementation issues
Issues related to implementing clinically studied parenting programs and applying them in ‘real life’ settings were
addressed by the research72 78, specifically those of fidelity, funding, training, effectiveness, flexibility, etc.9, 12, 55, 4, 124,
157, 158, 159 For example, Kumpfer et al. (2010) stress the importance of investing time in high quality training, as well
as including quality assurance measures in the intervention to ensure that the intervention is effective.104 Seng et al.
(2006) assert that “better fidelity of implementation presumably leads to stronger outcomes” (21).157 Nicholson et al.
(2010) stress that a concern with taking an intervention from a clinical trial to scale in a population is that the
participants in the community are much more diverse and come with multiple problems. 160 Shapiro, Prinz, and
Sanders (2010) add that another lesson learned in taking an evidence-based intervention to a population-level
implementation is the amount of time necessary to build momentum to impact a whole community.101
Access and equity concerns
The literature highlighted access and equity concerns for different families in their studies. These concerns include
barriers to participation in parenting strategies, increased risk of different disorders based on family factors, cultural
considerations for the appropriateness of parenting strategies, and strategies to address different barriers. Some of
the family factors that contributed to differential health experiences included low income, lower educational
attainment, and lack of partner support.65, 154, 161 For example, Breitenstein et al. (2007) suggest that “families in
poverty are among those facing the greatest challenges in raising young children but the least likely to access mental
health care”; thus, more needs to be done to encourage their participation in programs or to reach them in another
way (314).139 Barriers to participation in parenting strategies include financial constraints, chaotic family life, lack of
transportation, lack of time to participate, lower levels of education, and language barriers.51, 115, 154 Some of the
strategies mentioned in the different articles for addressing barriers to participation included offering parenting
programs in different languages, engaging families in the planning and implementation of parenting strategies to
address concerns of cultural relevance, providing child care and transportation, and offering food or compensation for
attendance. 12, 58, 89, 93, 97, 104, 120, 126, 137, 162, 163
Strategies to address access and equity concerns
Turner and Sanders (2007) suggests that “parenting programs need to be sensitive to the political and cultural
context in which parenting takes place, flexibly incorporate cultural practices and expectations, and develop an
evidence base of outcomes for families in diverse communities”(39).162 Kim et al. (2008) attributed the effectiveness
of the Incredible Years in influencing Korean mothers’ parenting practices to the fact that the program was delivered
by Korean American program facilitators who spoke Korean and who understood the cultural traditions.126 Dumas et
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
32
al. (2011) affirm that providing culturally grounded services is an important consideration for mental health services
for diverse populations.108 In developing the Spanish-version of Parenting Our Children to Excellence, Criando a
Nuestros Niños hacia el Éxito, Dumas et al. (2011) consulted with the community on what key cultural aspects
needed to be included in the program for it to be relevant to parents. The subsequent program evaluation found that
it was effective in increasing positive parenting practices and improving children’s social competence and
communication. Herschell (2010) cautions, however, that there is a fine line between being flexible in the delivery of
an evidence-based intervention to adapt to the unique needs of a group, and moving too far away from the core
components and content of the program.159
Another strategy to improve engagement of families considered higher risk in parenting interventions is to locate
them in community settings or an existing system that families are familiar with, like the school system.10, 50, 54, 89, 99
More points of access, or natural points of access for families increase the likelihood that parents will get connected
to the services that they need.120 The US Center for Disease Control recommends that parenting interventions need
to “start early, and to be locally based and accessible, particularly given that families most at risk may find it hard to
access conventional services” (1124).72 They further recommend partnerships between health organizations and
community or volunteer-based organizations to deliver parenting interventions.72 Scott et al. (2010) found that
building relationships with organizations, such as schools, where families may already have a relationship, would
help to engage families who may be considered hard-to-reach.89 Stormshak et al. (2005) found that basing a family
intervention program in a school increased their engagement with higher risk families and reduced teacher-reported
youth problem behaviour.50 Breitenstein et al. (2007) advocates for community-based parenting programs because
they are universal, they reduce the stigmatization, and they can be provided by an agency that the community
members are already familiar with and trust.138 For example, the Chicago Parent Program, a community-based
parenting program, is run at a local child care centre and includes an advisory committee made up of a diverse group
of community members. Evaluations of this program showed that it was effective in reducing behavioural problems
for young children of parents who participated.138 Similarly, employing peer-led approaches may help to engage
vulnerable populations or families from different cultural backgrounds. Matthews (2009) found that a peer-led
parenting group was effective in increasing positive parenting practices for teen moms when they have a clear focus
on parenting.79
Adapting programs to fit the unique needs of a population, or finding settings that are more inviting to families who
are at a higher risk, can help to reach those families that are harder to engage. For example, Nicholson et al. (2008)
looked at engaging parents who do not typically attend traditional parenting interventions through a unique positive
parenting intervention, music therapy. Results revealed greater effectiveness in engaging hard-to-reach families
because the music therapy environment was seen as more inviting and enjoyable.160, 164 Rodrigo, M.J. (2010)
recommends the following measures to encourage participation of ‘at-risk’ families in positive parenting strategies:
1. Parental support should be provided as an integrated part of policy development
2. Formal support should be universally available and provided in a non-stigmatizing way
3. Informal support should be promoted by creating and strengthening existing social bonds and
encouraging new links between parents and their family, neighbourhoods, and friends
4. Vulnerable families also need to strengthen their bonds to community life by empowering
parents and children’s associations and NGOs and activating a range of self-help and other
community-based groups and services (288).99
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
33
Moreover, Stolk et al. (2008) found that the relationship between the intervention facilitator and the
participant was a key factor in the success of the intervention, suggesting that the process is equally as
important as the content when trying to engage families.35
3.0 Environmental Scan
3.1 Positive Parenting Community Forum
In December 2010, a Positive Parenting Forum was held to provide community partners with examples of how a
comprehensive approach to positive parenting works in other communities and to gauge interest and capacity in
working towards a comprehensive approach in Waterloo Region. There were 38 individuals present at the forum,
representing 24 different organizations who work with families of children aged 0 to 12 years across Waterloo
Region. Participants were asked through small group discussions and a post-forum survey to provide their thoughts
on creating such a strategy and to identify any concerns that they might have in relation to this goal. The following
themes emerged:
•
•
•
•
The benefit of a comprehensive approach to positive parenting is that it creates a seamless system for
parents, where there is more coordination, collaboration and consistency between organizations.
The challenges of a comprehensive approach to a positive parenting strategy in Waterloo Region relate to
leadership (i.e., what organization would lead this strategy), cost (i.e., high cost associated with potentially
implementing Triple P), potential loss of programs currently provided in Waterloo Region, and how such a
strategy might be structured in Waterloo Region.
More information is needed to understand what positive parenting programs currently exist and where the
gaps are; what impact a comprehensive approach might have on existing programs; and how community
partners would contribute to planning a comprehensive positive parenting strategy.
Interest by most in exploring the issue further.
In May 2011, as a result of the community forum, a Positive Parenting Community Committee was established.
3.2 Positive Parenting Community Inventory Survey
A Positive Parenting Community Inventory Survey was developed to document positive parenting activities currently
being provided in Waterloo Region (see Appendix E for a copy of the survey).
A total of 117 organizations were sent the Positive Parenting Community Inventory Survey and 80 organizations
(68.4 per cent) completed the survey. Sixty organizations (75.0 per cent) lead at least one positive parenting activity
in Waterloo Region. A total of 158 positive parenting activities are provided across Waterloo Region by 60 (75.0 per
cent) organizations.
The survey data was analyzed to respond to the following three questions:
1. Do activities offered in Waterloo Region meet the definition of positive parenting provided in the literature?
2. When considered together, do positive parenting activities offered in Waterloo Region represent a
comprehensive approach?
3. Are the positive parenting activities in Waterloo Region evidence-based and/or evidence informed?
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
34
Do activities offered in Waterloo Region meet the definition of positive parenting provided in the literature?
Respondents were asked to identify the positive parenting elements, which are addressed in their activities, choosing
from the following list:
•
•
•
•
•
•
•
Warm or nurturing parenting (i.e., parents frequently talking, playing, praising, laughing and doing special
things together with their children)
Setting clear and consistent expectations or boundaries
Using praise for reinforcement of positive behaviours
Using non-punitive consequences for negative behaviours
Practicing a child-centered approach
Encouraging independence while maintaining monitoring behaviours
Other
Findings from the survey indicated that, according to the definition of positive parenting, the elements are
represented in the content of the activities across Waterloo Region. The most common elements of positive parenting
represented in the activities are promoting “warm/nurturing parenting” (16.4 per cent) and a “child-centred approach”
(16.2 per cent).
When considered together, do positive parenting activities offered in Waterloo Region represent a comprehensive
approach?
The following five main components represent a comprehensive positive parenting strategy:
•
•
•
•
•
Multidisciplinary practitioners
Multiple access points
Covers wide age range
Targeted and universal interventions
Coordinated, tiered levels of intervention, with different delivery methods
Respondents were asked to identify the professionals involved in planning or leading positive parenting activities.
The majority (51.3 per cent) of organizations indicated that positive parenting activities in Waterloo Region are
provided by multiple disciplines. While Early Child Educators and Social Workers were identified as most likely to
lead the activities, staff from many backgrounds were also responsible for providing the activities. These staff include,
but are not limited to, parents, peer or outreach workers, nurses, library staff, occupational or physical therapists,
speech pathologists, staff from faith-based organizations, and staff from schools. Respondents further identified if
each of their activities were offered by multiple disciplines. Of the 158 positive parenting activities, 38.0 per cent (60)
were part of a multidisciplinary strategy.
Multiple access points for positive parenting activities allow families to find information about services through various
organizations and/or access services at various locations. There are 154 unique locations for positive parenting
activities across the community, and 49 locations where more than one organization offers a positive parenting
activity.
Organizations were also asked whether they collaborated with at least one other organization for each of their
positive parenting activities. Of the 158 positive parenting activities described in the survey responses, 69.6 per cent
(110) were led in collaboration with at least one other organization.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
35
There is a wide range of age categories covered in the positive parenting activities across Waterloo Region;
however, most activities are targeted to families with children 0 to 3 years of age (34.9 per cent) and families with
children 4 to 7 years of age (28.9 per cent); see Figure 3.
Figure 3 Proportion of positive parenting activities by age range that positive parenting activities are geared towards
(years), Waterloo Region, 2011
50
45
40
Per cent of activities
35
30
25
20
15
10
5
0
Per cent of activities
Prenatal
17.1
0-3
34.9
4-7
8-12
28.9
11.4
Age category (years)
13-18
7.0
Not applicable
0.8
Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
Organizations were asked to indicate for each of their positive parenting activities whether they were universally
available or targeted to specific groups. Both universal and targeted approaches are covered, almost equally, by the
positive parenting activities in Waterloo Region. An overwhelming majority (92.4 per cent) of positive parenting
activities in Waterloo Region are free of charge for participants.
A comprehensive positive parenting approach infers community level coordination to ensure consistency in
messages, recognized points of access, and interventions that are easy to navigate and appropriate to the needs of
the family. While organizations were asked to identify activities that they provide in collaboration with other
organizations, there were no questions exploring coordination at a community level.
Having tiered levels of interventions, with different delivery methods, provides families with the sufficient amount of
support that they need in a way that is suitable. The following health promotion strategies are important delivery
methods to have included and coordinated in a comprehensive approach:
•
•
•
•
•
Social marketing and/or health communication (Social marketing)
Self-help, mutual aid or peer approaches (Self-help)
Group parent education or parent training (Group)
Individual parent education or parent training (Individual)
Advocacy
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
36
•
•
•
Policy development (Policy)
Multidisciplinary approach (Multidisciplinary)
Other
Figure 4 Proportion of positive parenting activities by health promotion strategy types, Waterloo Region, 2011
25
Per cent of activities
20
15
10
5
0
Per cent of
activities
Social
marketing
Self-help
Group
9.7
17.0
22.1
Individual
Advocacy
Policy
Multi
disciplinary
Other
15.7
12.7
4.9
10.4
7.5
Health promotion strategy type
Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
As illustrated in Figure 4, the positive parenting activities in Waterloo Region include all strategies outlined in a
comprehensive approach. Most strategies were identified as “Group parent education or parent training” (22.1 per
cent) or “Self-help, mutual aid/peer approaches” (17.0 per cent) or “Individual parent education or parent training”
(15.7 per cent). The strategy covered by the fewest activities is “Policy development” (4.9 per cent).
The importance of providing information to parents through technology-based strategies was emphasized in the
literature. In the survey, technology-based strategies were captured by the “Social Marketing” category and
represented only 9.7 per cent of documented activities. Further analysis revealed that of these activities, the most
frequently utilized strategy was “Pamphlets or Posters” (22.0 per cent) and technology-based strategies including
websites, email, Facebook, Twitter were even less likely to be used.
It is important to note that although all health promotion strategies are provided for families with children across all
ages, there are fewer positive parenting activities for ages 8 to 12 and 13 to 18 years across all the types of health
promotion strategies. (See Figure 5).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
37
Figure 5 Number of positive parenting activities by targeted age category and type of health promotion strategy,
Waterloo Region, 2011
120
110
100
90
Number of activities
80
70
60
50
40
30
20
10
0
Social marketing/Health communication
Self-help, mutual aid, or peer approaches
Group parent education or parent training program
Individual parent education or parent training program
Advocacy
Policy development
Multidisciplinary approach
Other
Prenatal
32
48
52
47
40
22
37
21
0-3
48
85
109
78
65
25
51
38
4-7
45
72
93
63
56
24
43
32
Age (years)
8-12
9
25
34
21
13
6
12
5
13-18
7
19
21
16
11
6
7
2
Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
Note: The ‘Not applicable” category was removed from the graph because of very low responses.
Even though the different health promotion strategies necessary for a comprehensive approach are covered and both
targeted and universal interventions are offered across the age span within our community, the data does not reveal
the depth or the breadth of the positive parenting activities. Moreover, it is unknown if positive parenting was a
primary or secondary focus of each of the positive parenting activities.
The coordination of levels of intensity, as described in the literature, is an essential aspect of a comprehensive
approach; but it cannot be objectively assessed from this analysis. More information may be necessary to evaluate
this important element of a comprehensive approach. For example, information about whether a continuum of care
exists in the community would help to answer whether there is coordination and tiered levels occurring. In addition,
information about the duration of positive parenting activities may help to assess the intensity of the health promotion
strategies.
Are the positive parenting activities in Waterloo Region evidence-based and/or evidence informed?
Evidence-based programs are those that are proven effective based on research studies or evaluation. Practicebased programs are those, which are developed based on client need as identified by the community, staff, or data;
or based on the experiences of staff. Respondents identified that the majority of the positive parenting activities
offered across Waterloo Region were developed based on evidence (64.6 per cent). On further analysis however, it
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
38
was identified that only 9.8 per cent were solely based on literature review or an existing program that has been
evaluated and the majority of evidence-based activities included practice-based sources for development.
It is important to note that the two evidence-based, comprehensive approaches (Triple P- Positive Parenting
Program, The Incredible Years) found in the literature review are not offered in Waterloo Region.
Evidence-informed activities were considered those in which an evaluation has been conducted. It is assumed that
future planning for the program will be informed from the results of the evaluation. The majority (51.3 per cent) of
positive parenting activities in Waterloo Region have not been evaluated.
3.3 What positive parenting activities does ROWPH lead?
The Positive Parenting Community Inventory Survey was completed by nine representatives in ROWPH and
identified 20 positive parenting activities being led by ROWPH.
When viewed in combination, the activities identified by staff cover the topics that are important in positive parent
activities (see Figure 6)
Figure 6 Proportion of ROWPH positive parenting activities by elements of positive parenting, ROWPH, 2011
100
90
80
Per cent of ROWPH activities
70
60
50
40
30
20
10
0
Percent of ROWPH activities
Warm/
nurturing
parenting
45.0
Clear
consistent
expectations/
boundaries
25.0
Praise
15.0
Non-punitive
consequences
Child-centred
approach
40.0
20.0
Elements of positive parenting
Encouraging
Independence
Other
20.0
80.0
Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
The majority of activities, however, fall under the “other” category; potentially indicating that positive parenting is a
secondary focus for most of the activities identified.
ROWPH positive parenting activities cover the wide age range from prenatal to 18 years; however, there are more
activities focusing on the early years (0 to 3 and 4 to 7 years).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
39
All of the health promotion strategies are covered by the ROWPH positive parenting activities with “Group parent
education or parent training” being the strategy that is used most often, and policy development being the strategy
that is the least applied. An examination of the health promotion strategies by age categories shows that although
each strategy is covered in all the age categories, age prenatal to 7 years are covered by more strategies than ages
8 to 18 years (see Figure 7).
Figure 7 Number of ROWPH positive parenting activities by health promotion strategy type and age category (years),
ROWPH, 2011
10
9
Number of ROWPH activities
8
7
6
5
4
3
2
1
0
Prenatal
0-3
4-7
8-12
13-18
Social marketing
3
2
2
1
1
Self-help
3
7
7
3
2
Group
Individual
4
7
6
7
7
5
3
2
2
2
Health promotion strategy type
Advocacy
2
1
1
1
1
Policy
1
1
1
1
1
Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
Note: The Not Applicable category was removed from the graph as the responses were very small. The “Other” category was also removed as there were no
responses.
Although both universal and targeted approaches are being applied for ROWPH positive parenting activities, almost
half of the activities are universal.
The majority (70.0 per cent) of ROWPH positive parenting activities are practice-based as compared to evidence
based with the majority being developed based on client need (community input or client need, or – staff input). Only
20.0 per cent of ROWPH positive parenting activities are developed based on literature review and 15.0 per cent
based on an existing program that has been evaluated. The majority (80.0 per cent) of ROWPH positive parenting
activities have not been evaluated.
3.4 Public Health Unit Survey
A survey of PHUs was conducted to explore the positive parenting strategies being utilized by similar PHUs in
Ontario, see Appendix F for a copy of the survey.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
40
Of the 10 PHUs that were sent the Public Health Unit Survey, nine PHUs (90.0 per cent) responded describing a total
of 99 positive parenting activities.
Seven PHUs responded that they use a multidisciplinary approach in their positive parenting activities.
All of the PHUs provide positive parenting activities with a face-to-face element at different sites.
There is diversity in the targeted age-range across PHUs, with most PHUs targeting the majority of their activities for
families with children 0 to 3 years of age, and for families with children 4 to 7 years age. Activities for families with
children 13 to 18 years of age are provided the least for most PHUs (see Figure 8).
Figure 8 Proportion of PHU positive parenting activities by age and by PHU, 2011
100
90
80
Per cent of activities
70
60
50
40
30
20
10
0
Prenatal
0-3
4-7
8-12
13-18
PHU 1
42.9
100
100
28.6
0.0
PHU 2
18.2
90.9
90.9
90.9
90.9
PHU 3
16.7
75.0
50.0
41.7
41.7
PHU 4
61.5
84.6
76.9
46.2
46.2
PHU 5
PHU 6
80.0
71.4
100
78.6
100
57.1
0.0
57.1
0.0
57.1
Public Health Unit (PHU)
PHU 7
28.6
78.6
71.4
21.4
21.4
PHU 8
0.0
72.7
63.6
54.5
18.2
PHU 9
14.3
100
92.9
50.0
0.0
Source: ROWPH (2011). Positive Parenting Public Health Unit Survey. Extracted August, 2011.
Furthermore, there are three PHUs that do not offer any positive parenting activities for ages 13 to 18 years, one that
does not offer any activities for prenatal age, and one that does not offer any activities for ages 8 to 12 years.
Half (49.5 per cent) of the activities reported were described as being both universal and targeted. PHUs described
21.2 per cent of their positive parenting activities to be exclusively universal.
All of the PHUs responded that they collaborate with other organizations to lead their positive parenting activities.
The degree to which PHUs worked within community-level coordination system was not assessed.
Similar to the results of the Positive Parenting Community Inventory, the most frequent strategy employed for PHUs
is the “Group parent education or parent training program”, with all nine PHUs responding that they provided this
strategy (see Figure 9).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
41
Figure 9 Number of PHU positive parenting activities by health promotion strategy type, 2011
10
9
8
Number of PHUs
7
6
5
4
3
2
1
0
Number of Public Health Units
Social
marketing
7
Self-help
Group
6
9
Individual
Advocacy
8
6
Health Promotion Strategy Type
Policy
Other
4
2
Source: ROWPH (2011). Positive Parenting Public Health Unit Survey. Extracted August, 2011.
Only two PHUs indicated that they provide all of the positive parenting health promotion strategies that would
comprise a comprehensive approach.
While pamphlets remained the predominant social marketing strategy related to positive parenting (used by seven
PHUs), four PHUs are utilizing e-newsletters, and three PHUs are utilizing Facebook and radio strategies for
communication related to positive parenting.
Three of the nine PHUs offer the full range of the Triple P positive parenting strategy and one PHU offers one level of
Triple P to supplement other positive parenting activities happening in their community to make up a comprehensive
approach. One PHU offers the Incredible Years positive parenting strategy. While PHUs were not asked if their
activities were developed based on evidence, both Triple P and The Incredible Years programs have been proven
effective by multiple evaluation studies.
Finally, PHUs were asked to provide some insights into the implementation process for their positive parenting
activities. The following themes emerged:
•
•
•
•
•
•
Need to work with community partners and take a collaborative approach
Essential to define target group prior to implementing
Important to have continuous skill development for those delivering services
Specific strategies seem to work best, including brief, structured strategy built on evidence
Need to have sustainable funding
Need to consider how to address barriers to engagement
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
42
The results from the Public Health Unit Survey suggest that there is much that can be learned from those PHUs that
are involved in or even leading evidence-based comprehensive positive parenting approaches in their community.
Follow up may be necessary to garner the full picture of what worked well and what did not.
3.5 What do parents have to say?
Although consultations with parents were not conducted as a part of this project, a few documents provide some
insight into parents’ perspectives of needs for positive parenting.
In the process of the One Stop project, a study exploring co-locating programs and services for children 0 to 6 years
and their families, a sample of local parents identified that an important topic to include in any multi-use community
site was “parenting education and support related to behaviour and discipline, bonding with a newborn and
attachment parenting, preparing to be a parent and what to expect, how to deal with toddler issues such as sibling
jealousy, temper tantrums”, etc (57). 165 Parents who were consulted also highlighted the desire to have more
seamless services, with more collaboration and coordination between organizations.
In the Invest in Kids national survey of Canadian parents, “only about 25 per cent of mothers and fathers reported
strong support in their parenting role from their neighbourhood community, and 16 per cent of mothers and 13 per
cent of fathers feel very unsupported by their neighbourhood community” (7).36 The purpose of the Invest in Kids Vital
Communities, Vital Support study is to explore how best to support parents in their role as parents and then to
examine how this fits with child development outcomes. This study found that social supports, i.e. support from
people in their lives as well as attitudes about parents’ role in their community, were key influences in their parenting
practices. In terms of what kinds of supports parents are seeking, this study found that “the more that resources and
programs are universal (versus targeted or remedial), informal, unstructured, flexible and non-judgmental about one’s
parenting, the more likely parents rated them as ‘very important’ and used them when they were thought to be
available” (8).36 Parents were also asked in a focus group about what tangible supports and intangible supports they
would like from their community to support them as parents, see Table 2 for the themes that emerged from the
responses.
Table 2 Tangible and intangible supports that parents seek, Canada, 2006
Tangible supports
Intangible supports
Professionals who pay attention to us
Genuine caring for one another
A link from hospital to community
Respect for different family definitions
Help to find out what is available
Mutual respect and understanding
Consistent advice on parenting
Welcomed to step out with my baby
Non-denominational gatherings
More peaceful, less chaotic physical environment in the community
Less crowded preschool programs
Acceptance of our struggles so we can step out in our weakest moments
Public places to get involved with our kids – not just
Variety in our life with baby
drop them off
More and better community centres
Guidance that continues after baby’s first year
Friendlier more flexible program administration
Dad specific – Appreciation of our attempts to be less aggressive
Community events to get me out
Dad specific – Understanding when we feel exhausted from work
Childcare and temporary care
Dad specific – Trust in our parenting approach
Safer streets
Dad specific – Widespread embracement of parental leave
Dad specific – Public feeding rooms, change tables and
diapers in our washrooms
Dad specific – off hour community centres and events
Source: Crill Russell, C., Birnbaum, N., Avison, W.R., and Ioannone, P. (2011). Vital Communities, Vital Support. How well do Canada’s communities support parents of young children? Phase 2 Report: What
parents tell us. Accessed September 26, 2011 at: http://www.phoenixpembroke.com/sites/default/files/Community_Vitality_Phase_2_FINAL_REPORT.pdf.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
43
A limitation to this data; however, is that only parents who were living together or married were surveyed. There are
many other family structures in Canadian society; thus, these results may not be representative of all parents’
perspectives. The survey was also limited to families of children aged five and younger; therefore, it only provides the
perspective of parents with young children.
Themes identified include the need for coordination between organizations that provide support, informal ways to
connect with families; and universal programs that reduce the judgment of seeking support.
3.6 Limitations
A limitation of the data collected in both the Positive Parenting Community Inventory Survey and the Public Health
Unit Survey is that the full literature review was not completed when the survey tools were developed; thus, the full
understanding of the necessary elements for both a positive parenting strategy and a comprehensive approach may
not have been fully incorporated in the survey tool. For example, questions in regards to the level of coordination
between organizations were not included in the Positive Parenting Community Inventory Survey as they may have
been otherwise.
A technical error occurred with the electronic survey software, I:survey, that was used for collecting the Positive
Parenting Community Inventory Survey responses. Unfortunately, data provided by organizations on the following
two text box questions was lost:
Question 8.a) Please indicate the populations that you target (e.g. young parents, parents living with
low income, parents of children with developmental disabilities, etc.):
Question 11.a) Do you collaborate on this positive parenting activity with other organizations? If yes,
please list:
It was decided that responses to Question 11.a) was sufficient without the list of organizations with whom they
collaborated. However, Question 8.a) was a critical question on the survey since the responses provide information
on who the priority populations are within Waterloo Region. It was decided to contact each organization that had
responded that their positive parenting activity was either “Only open to certain groups (Targeted)” or “Both
(Universal and Targeted)” to respond to the target population question over the phone. Some original responses to
this question may not have been captured.
A further limitation to the Positive Parenting Community Inventory Survey methodology was the timing of the survey.
It was distributed during summer months; thus, a few organizations may not have responded or the most appropriate
person to respond to the survey may not have been available due to the frequency of vacations during this time
period.
Finally, adequate information was not available to validate the quality of the evidence for activities described as
evidence-based.
4.0 Priority Populations
“Priority populations are identified by surveillance, epidemiological, or other research studies and are those
populations that are at risk and for whom public health interventions may be reasonably considered to have a
substantial impact at the population level” (2). 166
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
44
A list of priority populations for positive parenting was generated through analysis of all components of this project,
and was further discussed and confirmed by community surveillance and data sources, as well as key informant
discussion. Table 3 provides a summary of the sources which helped to identify priority groups. The following eight
priority populations for positive parenting were identified:
•
•
•
•
•
•
•
•
Families with children 0 to 6 years of age
Families at high risk* for negative health outcomes
Families living in low income or socially disadvantaged neighbourhoods
Families involved with child protection services (or have experienced or witnessed abuse or neglect)
Families led by a young parent or parents
Families who are New Canadians, immigrants, refugees, parenting in two cultures
Families with children living in rural areas
Families with children with special needs (children with conduct disorders, developmental disability, mental
health concerns, and/or who are gifted or talented)
*Note: ‘High risk’ families were identified through a number of sources without providing a definition for this priority
population. Families with higher risk factors could be many different family types including priority populations already
identified, for example, young parents could also be considered high risk families. However, in the literature review
one article described ‘high risk’ families as those experiencing substance abuse, parent incarceration, marital
problems, unemployment, neglect or abuse, and/or poor parenting skills.150 More consultation may be needed to
define what is meant by ‘high risk’ families.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
45
Table 3 Comparison of identification of priority populations
Priority Population
Literature
Review
Families with children 0 to 6 years of age
Families at high risk for negative health outcomes
Families living in low income or socially disadvantaged
neighbourhoods
Families involved with child protection services (or
experience or witness abuse or neglect)
Families led by a young parent or parents
Families who are New Canadians, immigrants, refugees,
parenting in two cultures
Families with children living in rural areas
Families with children with special needs (conduct disorders,
developmental disability, mental health issues, gifted or
talented)
Fathers specifically
Foster parents/adoptive parents
New parents
Parents from certain cultural backgrounds
Parents from other specific groups, such as parents of
multiple births, parents from Low German Mennonites from
Mexico, parents of specific religious practices
Parents with less social supports or unsupportive
environment, socially isolated
Parents engaging in problematic substance use
Single parenthood
Specific language - Francophone, ESL
Boys
Divorced or separated parents
Families who experience a loss
First Nations
Grandparents raising grandchildren
LGTBQIA
Low parent education
Mothers specifically
Mothers who experience stress or depression
Transition years



Positive Parenting
Community
Inventory Survey



Public
Health Unit
Survey



Advisory
Committee
Consultation
















































4.1 Local data to confirm priority populations
Methodology
In exploring priority populations for positive parenting activities in Waterloo Region, direct measures of parenting
practices based on socio-economic or other risk factors were sought out. Due to a lack of sources of local data on
parenting, proxy indicators for parenting were explored, i.e., indicators of children’s behavioural outcomes known to
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
46
be influenced by parenting practices. Neighbourhood-level characteristics were also explored in relation to childhood
indicators of risk for two reasons: (1) the literature points to links between lower levels of neighbourhood supports
and behavioural problems in children, and (2) there were neighbourhood risk factor data was available as a proxy for
individual risk factor data to compare with childhood risk indicators.
Limitations
Although the intention was to use client data from local organizations who work with families with children who are
experiencing behavioural or developmental concerns to assess if there are family factors that identify certain priority
populations, there were limitations to gathering this data. Local organizations do not necessarily collect sociodemographic information about the families that they support nor do they have databases in place to easily extract
data for this purpose. More information may need to be collected from local organizations and/or data collection tools
may need to be developed to further assess who are the local priority populations for positive parenting.
One of the only existing parenting indicators that is collected is a measure of parenting consistency. The Rapid Risk
Factor Surveillance System (RRFSS) collects information on the level of parenting consistency, with a higher score
indicating that parents are more often engaged in positive parenting activities. The positive parenting activities
measured include “praising their child; talking or playing with their child; laughing with their child; doing something
special with their child that the child enjoys; and playing games with their child” (1). 167 In 2008, a random
representative sample of parents in Waterloo Region indicated that 54.0 per cent of respondents scored in the high
range for consistently engaging in parenting activities. There were no significant differences in the range of parenting
consistency scores based on sex, household income, education or place of residence.167 Moreover, younger parents,
aged 18 to 34 years, had a higher consistency score than older parents, aged 35 years and above.167 This
information is contradictory to other data sources reviewed which suggest that socio-economic characteristics of
parents do affect their parenting practices. For example, the literature suggests that being a younger mother will have
more negative impacts on parenting and yet these results show older mothers are less consistent. Limitations to this
study; however, are the small sample size, the self-reported nature of the data and the fact that it is a telephone
survey. The responses may be influenced by social desirability bias, meaning that respondents may provide an
answer that they believe will be viewed most favorably by others.
One Stop Project priority populations
Because the One Stop project was an impetus for this project, it was recommended to review the priority populations
identified by the One Stop project as another step in validating the priority populations. Although the topic area for the
One Stop project was specific to co-location of services for families of children aged 0 to 6 years, the priority
populations identified complement some of the populations identified through this project; they include:
•
•
•
•
Rural communities
Young mothers
People new to Canada (Immigrants and Refugees)
People living in poverty.165
Furthermore, when service providers were asked about the most prevalent barriers that their clients experience, they
“emphasized that the families they meet are often dealing with numerous barriers to services which tend to overlap
creating situations that are more complex and entrenched. In particular, families’ culture, values, and emotional wellbeing or stress level were identified as critical factors affecting families’ ability or willingness to seek out services”
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
47
(58).165 This information corroborates that ‘high risk’ families may be priority populations as they tend to face multiple
stressors that interfere with their ability to access support and services.
Priority Population: Families with children 0 to 6 years of age
It is well established that the first six years of life, starting at preconception, are
critical for healthy child development.39 Local data from the HBHC Post Partum
Assessment, including the Parkyn Postpartum Screen (Parkyn), and the Early
Development Instrument (EDI) demonstrate that there are young children in
Waterloo Region who can be considered at risk for poor developmental outcomes.
The effectiveness of positive parenting interventions tend to be measured by
examining indicators related to child conduct disorders or behavioural problems.
Therefore, it is important to understand behavioural problems in children at a local
level. Furthermore, the literature highlighted the interrelatedness of harsh
parenting and children’s behavioural problems.
The HBHC Post Partum
Assessment Parkyn
Postpartum Screen (Parkyn)
provides a score that
considered the risk of various
parental risk factors impacting
health outcomes in children. It
is conducted with families in
the immediate days following
a child’s birth.
The Early Development
Instrument (EDI) is a tool to
measure school readiness in
children and is conducted with
families who have a child in
senior kindergarten.
Results from the EDI (2010) showed that 6.2 per cent of children had either an
observed (4.6 per cent) or a diagnosed behaviour problem (1.6 per cent). 168 Emotional problems in children were
also identified, as were special concerns with the home environment, yielding the following information related to
families in Waterloo Region:
•
•
3.9 per cent of children were identified as having either an observed (3.0 per cent) or diagnosed (0.9 per
cent) emotional problem.
3.6 per cent of children were identified as having either an observed (2.7 per cent) or diagnosed (0.9 per
cent) special concern with home environment/problems at home.
The average age of a child on the EDI is approximately five years old, which means that these are children identified
with a behavior problem early in life. Note that a limitation to this indicator is that children are not usually diagnosed
for behavior problems this early in life; thus, this may be an underrepresentation of the prevalence of behavior
problems in this population.
Priority Population: Families at high risk for negative health outcomes
The Parkyn screen provides an overall measure of risk for health and developmental difficulties in newborn infants
and yields a calculated risk score, which, among other factors, considers the presence of several parental risk factors
including parenting difficulties, financial difficulties, family violence, marital distress, family composition and related
social supports, maternal low education and postpartum depression. These parental risk factors are consistent with
the literature reviews’ findings of factors associated with increased risk for developmental difficulties in children. For
example, the literature review highlighted that maternal depression is a major risk factor for parents using harsh
parenting and/or children developing behavioural problems, and postpartum depression is a family risk factor
assessed in the Parkyn risk score. In 2010, 18.7 per cent of infants screened at risk according to the Parkyn
screen. 169
Priority Population: Families living in low income or socially disadvantaged neighbourhoods
The literature review highlighted that behavior problems can be affected by the child’s environment. Both
neighbourhood and family risk factors, such as income level, community supports, and education level, can affect
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
48
parenting practices as well as children’s development, including behavioural
development. For this purpose, an indicator of neighbourhood socioeconomic status was used to explore the relationship between
neighbourhood disadvantage and developmental risk indicators for children.
A NESI score of 0 indicates that the neighbourhoods have low socioeconomic risk whereas a score of 5 to 6 indicates that the neighbourhood
has high socio-economic risk. For more information on the NESI score, see
Appendix G.
The Neighbourhood Economic
Security Index (NESI) is a
composite of the six socioeconomic factors including
unemployment rate, low
income families, education,
family structure, rental
housing, and household
spending.
Figure 10 Neighbourhood-level risk factors by neighbourhood economic security index (NESI) level, Waterloo
Region, 2006, 2010
30
25
Mean percent at risk
20
Mean per cent scoring low on two or more EDI
domains
15
Mean per cent at risk on Parkyn
Mean per cent with observed or diagnosed
behavior problem on EDI
10
5
0
0
1-2
NESI risk level
3-4
5-6
Source: Region of Waterloo Public Health. (2010). HBHC-ISCIS Reporting Sub-System. Parkyn Postpartum Screen data between January 1, 2010 and
December 31, 2010. Extracted August 17, 2011. KW YMCA Ontario Early Years Centre. (2010). Early Development Instrument data for Waterloo Region for
2009/2010 school year. Data retrieved from Amy Romagnoli on August 3, 2011., Tardiff, E. (2009). A Community Fit for Children. A Focus on Young Children in
Waterloo Region. Second Edition.
Statistically significant relationships were found between the NESI scores and the mean per cent of children at risk
on the Parkyn (p <0.001), the mean per cent of children scoring low on two or more EDI domains (p=0.001), and the
mean per cent of children with an observed or diagnosed behavior problem on the EDI (p=0.014); see Figure 10.
A correlation between the per cent of children 0 to 18 years with low income status by neighbourhood and the per
cent of children scoring low on two or more EDI domains was also performed. There is a statistically significant but
low to moderate correlation between children 0 to 18 years with low income status and EDI vulnerability by
neighbourhood, r=0.433, p=0.006. When the EDI vulnerability was correlated separately with each of the age
categories with low income status by neighbourhood, the category of children 0 to 3 years with low income status had
the strongest correlation to EDI vulnerability, r=0.604, p<0.001.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
49
This neighbourhood-level analysis of different risk indicators supports the literature review finding that children who
live in lower socio-economic neighbourhoods or neighbourhoods with less support may be more vulnerable to early
development challenges and at a higher risk for experiencing negative outcomes in life.
Priority Population: Families involved with child protection services (or have experienced or witnessed
abuse or neglect)
Children whose families are involved with child protection services are clearly a priority population for positive
parenting as often these children have already experienced harsh or abusive parenting. An estimated 7.4 per cent of
children aged 0 to 18 in Waterloo Region were involved with Family and Children’s Services of the Waterloo Region
(FACS) in 2010. Emotional harm, caregiver capacity, neglect, and physical harm are among the most prevalent
primary reasons for referral at intake to FACS in 2010/2011; see Figure 11.
Figure 11 Proportion of FACS clients by primary reasons for referral at intake, Waterloo Region, 2010/2011
50
45
40
Per cent of FACS clients
35
30
25
20
15
10
5
0
Percent of FACS clients
Abandonment
7
Caregiver capacity
28
Emotional harm
Neglect
29
15
Primary reason for intake
Physical harm
15
Sexual harm
5
Source: Family and Children’s Services of the Waterloo Region. (2011). 2010-2011 Annual Report. Accessed September 2011 at: www.facswaterloo.org.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
50
Figure 12 Number of FACS active protection cases by age, Waterloo Region, 2010
650
600
550
Number of active protection cases
500
450
400
350
300
250
200
150
100
50
0
0
Number of cases 349
1
571
2
551
3
610
4
523
5
532
6
545
7
535
8
9
10
501 518 467
Age (years)
11
451
12
484
13
491
14
488
15
500
16
391
17
187
18
164
Source: Family and Children’s Services of the Waterloo Region. (2010). Active child protection cases between January 1, 2010 and December 31, 2010.
Retrieved from Jill Stoddart on September 21, 2011.
In 2010, there were active child protection cases for children of all ages; however, number of active cases were
highest for children ages 1, 2 and 3 years (number of cases were 571, 551, 610 respectively); while the lowest
number of cases was related to children 17 and 18 years of age for the same year (187 and 164 cases); see Figure
12. 170
The HBHC Prenatal Screening and Assessment, including the Larson Prenatal Screen, conducted by ROWPH
provides a glimpse of the number of families involved with FACS during the prenatal
The Larson Prenatal
period. One hundred and three women reported that they were involved with FACS on the
Screen conducted by
Larson screen in 2010. A limitation to this data is that not all families are screened
PHNs allows for
early detection of
prenatally; approximately 72.0 per cent of all births in Waterloo Region are screened.
families who may
need support to help
their children reach
their potential.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
51
Figure 13 Proportion of mothers screened with Larson who were involved with FACS prenatally by age of mother,
Waterloo Region, 2010
Per cent of women with Larson screen involved with FACS
25
20
15
10
5
0
Per cent of women with Larson screen involved
with FACS
19 years and
under
20-25
26-30
31-35
36 and over
Unknown
20.3
4.6
1.5
0.8
0.6
0
Age category (years)
Source: Region of Waterloo Public Health. (2010). HBHC-ISCIS Reporting Sub-System. Larson Prenatal Screen data between January 1, 2010 and December
31, 2010. Extracted October 31, 2011.
Figure 13 shows a considerable overrepresentation of women 19 years of age and under involved with FACS at the
time the prenatal screen was administered.
The number of child protection cases also differs by neighbourhood. A comparison between neighbourhoods based
on socio-economic risk level and active child protection cases was conducted and a statistically significant
relationship was found (p=<0.001). Neighbourhoods with higher socio-economic risk levels seem to have higher
cases of active child protection cases (see Figure 14).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
52
Figure 14 Mean proportion of population 0 to 18 years with active FACS cases by NESI, Waterloo Region, 2006,
2010
25
Mean proportion
20
15
10
5
0
Mean proportion of population 0-18 in
neighbourhood with active protection case
0
1-2
3.5
5.2
NESI risk level
3-4
5-6
8.3
12.1
Source: Family and Children’s Services of the Waterloo Region. (2010). Active child protection cases between January 1, 2010 and December 31, 2010.
Retrieved from Jill Stoddart on September 21, 2011., Tardiff, E. (2009). A Community Fit for Children. A Focus on Young Children in Waterloo Region. Second
Edition.
The effects of experiencing or witnessing abuse can be traumatizing and long lasting. Access to outcome data for
children who have witnessed or experienced abuse was not available for this project.
Priority Population: Families led by a young parent or parents
The literature indicates that young parents have more socio-economic risk factors related to harsh parenting. The
average age of mothers at time of delivery in Waterloo Region in 2010 is 29.6 years; the per cent of mothers 19
years old and younger is 3.7 per cent. 171 Figure 15 indicates the proportion of women identified at risk according to
the Larson Prenatal Screen by maternal age. It should be noted that educational factors was usually the reason that
young mothers received a positive at risk screen (i.e., young mothers had not completed high school).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
53
Figure 15 Proportion of infants at risk on Larson by mother’s age, Waterloo Region, 2010
100
90
80
Per cent of infants screened
70
60
50
40
30
20
10
0
Percent of infants at risk
19 years and
under
89.5
20-25
26-30
31-35
36 and over
50.6
22.5
Age category (years)
13.3
13.2
Source: Region of Waterloo Public Health. (2010). HBHC-ISCIS Reporting Sub-System. Larson Prenatal Screen data between January 1, 2010 and December
31, 2010. Extracted October 31, 2011.
*Pregnant women are considered at-risk with Larson scores of 13 or higher.
Note: The category ‘Unknown’ was removed as there were less than five per cent of respondents in this category.
Women aged 19 years and under make up 4.3 per cent of mothers screened on the Larson; but, 89.5 per cent were
screened at risk.
Priority Population: Families who are New Canadians, immigrants, refugees, parenting in two cultures
In 2006, 22.3 per cent of Waterloo Region’s population was made up of immigrants, which is more than one-fifth of
the population. 172 The proportion of recent immigrants (immigrated within the last five years) who are 15 years and
younger is higher than the proportion of the total population 15 years and younger in Waterloo Region. 173
Refugees fleeing violence or persecution make up 15.6 per cent of people who immigrated to Waterloo Region in
2008. 174 These families may be at risk for negative outcomes depending on the trauma they may have experienced
on their journey. Risk factors such as low income, less social supports and a history of trauma and depression are
the contributing factors for identifying people who are New Canadians and immigrants as priority populations for
positive parenting interventions.“In 2006, 30.2 per cent of recent immigrants had low incomes compared to 10.2 per
cent for the Canadian-born population…this gap decreases the longer the immigrants have been in Canada but
remains relatively higher than for those who were born in Canada”(3). 175 Furthermore, the proportion of the immigrant
population in Waterloo Region who describe their sense of belonging to the community as “very weak” is much
higher than the proportion of Canadian-born residents; 24.1 per cent of immigrant population versus 7.0 per cent of
Canadian born population (4).175 Sense of community may be related to the amount of support that immigrant parents
have in their role as parents, which is a factor affecting positive parenting practices.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
54
To examine further whether people who are New Canadians should be considered a priority population in Waterloo
Region, a correlation test was performed to see if the Parkyn risk level by neighbourhood was related to the
percentage of recent immigrant families in those neighbourhoods. A statistically significant but low correlation exists
between the per cent of recent immigrants and the per cent of children at risk on the Parkyn, r=0.393, p=0.009. There
is a statistically significant, but low, correlation between the proportion of recent immigrants by neighbourhood and
the proportion of children who were screened as vulnerable according to the EDI, r=0.412, p=0.009. This suggests
that neighbourhoods with a higher rate of recent immigrants may have greater proportions of children vulnerable to
school readiness concerns.
Priority Population: Families living in rural areas
Local risk factor data indicates that children living in rural areas (townships) are less vulnerable to developmental
difficulties, school readiness concerns, behaviour problems and involvement with FACS than children living in urban
areas (cities); see Figure 16. However, consultation with various stakeholders revealed that, although children living
in rural areas may not have as high a risk, they tend to have less access to services and may also be
underrepresented in the data sources used. For example, children who attend parochial schools, who most likely live
in the townships, are not included in the EDI; thus, vulnerability to school readiness is not calculated for these
children. Accessing services becomes further problematic for families with low incomes or families experiencing other
risk factors such as mental illness, potentially leading to more significant concerns.
Figure 16 Risk factor data by rural versus urban populations, Waterloo Region, 2010
25
Per cent of population
20
15
10
5
0
Townships
Cities
Parkyn risk
EDI vulnerability
14.3
18.33
10.18
16.94
Observed or diagnosed
behaviour problem
3.76
6.55
Risk indicator
Active FACS protection case
3.8
7.61
Source: Region of Waterloo Public Health. (2010). HBHC-ISCIS Reporting Sub-System. Parkyn Postpartum Screen data between January 1, 2010 and
December 31, 2010. Extracted August 17, 2011., KW YMCA Ontario Early Years Centre. (2010). Early Development Instrument data for Waterloo Region for
2009/2010 school year. Data retrieved from Amy Romagnoli on August 3, 2011., Family and Children’s Services of the Waterloo Region. (2010). Active child
protection cases between January 1, 2010 and December 31, 2010. Retrieved from Jill Stoddart on September 21, 2011.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
55
Exploration of other indicators of risk may be necessary to determine whether families living in rural areas are priority
populations for positive parenting interventions.
Priority Population: Families with children with special needs (children with conduct disorders,
developmental disability, mental health concerns, and/or who are gifted or talented)
The literature suggests that children with special needs might be at a higher risk for behavior problems. A number of
organizations (e.g., Kidsability, KidsLINK) in Waterloo Region provide services for families with children with a wide
range of special needs in including children with developmental disabilities, medical syndromes such as Down
syndrome, coordination disorders, ASD; physical disabilities such as muscular dystrophy, spina bifida and cerebral
palsy; communication difficulties, and mental health concerns such as depression, anxiety, conduct disorders. While
it is acknowledged that families with children with special needs should be considered a priority population, sufficient
local data was not available to either discount or confirm that this is the case in Waterloo Region.
Summary remarks: Who are the priority populations for positive parenting interventions in Waterloo
Region?
In summary, there is very little evidence to either support or challenge the priority populations identified through this
process. What is known, both through the literature as well as through the childhood risk factors reviewed, is that
there are parents in Waterloo Region in need of more support. They include those families living in neighbourhoods
characterized by lower socio-economic status and those experiencing higher levels of stress for various family
circumstances, especially during the early years when children’s development is highly influenced by their
environment. More exploration into priority populations, including a closer look at the populations identified, would be
beneficial to further narrow down what families are more in need of supports and services. Identification of other local
data sources could potentially help with this further analysis.
5.0 Gaps Analysis
The following questions were explored using the data from the environmental scan to identify gaps in services in
Waterloo Region:
•
•
•
Are the elements of the comprehensive approach covered?
Are there activities for each of the strategies covered for priority populations?
Are the positive parenting activities located where those who need the services are located?
As previously discussed, although it seems as though there is a comprehensive approach happening already in
Waterloo Region, it was not possible to confirm whether a coordinated approach with tiered levels of intensity is
occurring in Waterloo Region. Neither of the two evidence-based, comprehensive approaches (Triple P, Incredible
Years) identified in the literature review are happening in Waterloo Region, at least not in the comprehensive sense.
There are gaps for priority populations in the health promotion strategies across the age ranges. The following table,
Table 4, identifies where there are gaps in services for priority populations:
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
56
Table 4 Gaps in services for priority populations, Waterloo Region, 2011
Priority population
Families with children
0 to 6 years of age
Families at high risk
for negative health
outcomes
Families living in low
income or socially
disadvantaged
neighbourhoods
Families involved
with child protection
services
Families led by a
young parent or
parents
Families who are New
Canadians,
immigrants, refugees,
parenting in two
cultures
Families with children
living in rural areas
Families with children
with special needs
Universal
Social marketing
0- 4- 8- 13Pre 3
7
12 18






NA
NA















Self-help
4- 87
12
1318
Pre
03
Group
4- 87
12
1318
Pre
03
Individual
4- 87
12
1318
1318
Pre
03




Pre



NA
NA



NA
NA



NA
NA



NA
NA































































































































Source: ROWPH (2011). Positive Parenting Community Inventory Survey. Extracted August, 2011.
Legend

Pre
Advocacy
0- 4- 83
7
12
03
= Shading represents where there are a lack of services offered
= At least one organization offers an activity that covers this population, health promotion strategy and age range
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
57
Policy
4- 87
12
1318
NA
NA





















Exploration of services which are provided in Waterloo Region and that are targeted for the priority populations,
revealed some gaps. A “gap” indicates where there is total lack of services for a priority population; there was no
assessment to measure how the existing targeted programs are actually meeting the needs of the populations
identified. Therefore it should not be assumed that needs are being met based on the existence of a program alone.
Moreover, some “gaps” identified may be warranted as there may be no need for that specific service.
Table 4 reveals that there are no social marketing/health communication strategies for target populations in the 13 to
18 age category. Furthermore, gaps in policy strategies for priority populations are most prevalent. The table also
highlights that there is less access to services for families living in rural areas. However, a few limitations to this data
need to be addressed. It is important to note that the information contained in this table is self-reported data and may
not provide a complete snapshot of service for priority populations in Waterloo Region.
The positive parenting activities identified through the Positive Parenting Community Inventory Survey were mapped
to examine whether the activities were located in areas where there was higher need; see Figure 17.The locations of
positive parenting activities were mapped on top of the NESI risk level of the neighbourhoods and indicate that the
positive parenting activities are located in the higher risk neighbourhoods.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
58
Figure 17 Locations of organizations with positive parenting programs, by neighbourhood and NESI score, Waterloo Region, 2006, 2011
Source: Statistics Canada Census (2006) Neighbourhood Economic Security Index, extracted August 10, 2011.
The map also reveals a much higher concentration of positive parenting activities being offered in the ‘downtown core’ areas of the municipalities of Cambridge,
Kitchener and Waterloo and few activities occurring in the rural areas. This trend existed when the data was analyzed by age, especially for families with children
13-18 years of age, where across all four townships, only three positive parenting activities were offered, see Figure 18.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
59
Figure 18 Locations of organizations with positive parenting programs for children aged 13 to 18 years, by neighbourhood and NESI scores, Waterloo Region,
2006, 2011
Source: Statistics Canada Census (2006) Neighbourhood Economic Security Index, extracted August 10, 2011.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
60
An examination of the locations of positive parenting activities in relation to the population of children was also conducted (see Figure 19) and highlights
neighbourhoods with higher numbers of children with few positive parenting supports (e.g. Eastbridge/Lexington and Shades Mills).
Figure 19 Positive parenting activities by neighbourhood and population of children aged 0 to 18 years, Waterloo Region, 2006, 2011
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
61
Figure 19 shows that there may be some gaps in terms of meeting the needs of families living in neighbourhoods
with higher populations of children aged 0 to 18 years. It also shows the minimal access to positive parenting
activities in rural areas. Moreover, population projection estimates show that three out of the four townships are
expected to have higher increases in population aged 0 to 6 years than the cities; see Table 5. The townships
currently have very few positive parenting activities located within them. This gap in services may become more
problematic as the population grows over the next 25 years.
Table 5 Population projections children aged 0 to 6, Waterloo Region, 2006
Municipality
Population 0 to 6 years Population 0 to 6 years in
in 2006
2031 (projected)
Cambridge
10,490
13,667
Kitchener
17,281
23,115
Waterloo
7,509
8,944
North Dumfries
817
1,372
Wellesley
1,400
1,817
Wilmot
1,170
1,670
Woolwich
1,716
2,567
Percentage increase
(%)
30.3
33.8
19.1
67.9
29.8
42.7
49.6
Source: Region of Waterloo Public Health. (2006, September). FH Human Services Report. Waterloo, ON: Sharmin Jaffer.
6.0 Best Practices
Best practices are those which have been proven to be effective through research (i.e. evaluation). There was very
little literature referring specifically to ‘best practices’ for positive parenting practices. For the purpose of this report,
‘best practices’ were gleaned from multiple sources including articles found through the literature review, the
Canadian Best Practices Portal, and guidance from the PHU survey. Here is a summary representing an overview of
findings:
•
•
•
•
•
A comprehensive health approach is the best way to meet the largest proportion of the population and to
reach marginalized members of the community.
Mediators of program effectiveness identified included promoting parents’ self-efficacy, involving direct
practice, and ensuring content fit for parents’ needs.
Triple P and the Incredible Years were two programs shown to be effective through many research studies.
Canadian Best Practices Portal revealed 16 parenting interventions considered to be evidence-based best
practices, see Appendix D.
Lessons learned from the Public Health Unit Survey included the importance of community collaboration,
implementing a structured, evidence-based program, providing ongoing staff training, and having a mix of
interventions; see Appendix H for all themes from lessons learned.
Determining best practices for positive parenting activities may need to be further pursued.
7.0 Suggested actions
Consultations on the findings took place with three different stakeholder groups: the Positive Parenting internal
Advisory Committee, a group of cross-divisional managers in ROWPH, and the Positive Parenting Community
Committee.
Some of the emerging themes for action from these consultations include exploring the following:
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
62
•
•
•
Determination of the current level of coordination between positive parenting activities.
How to address the gaps for priority populations and whether there are unmet needs in the community.
Policy development to promote positive parenting.
8.0 Conclusion
Supporting children’s development begins with supporting parents in their critical role of nurturing, teaching, and
providing for their children’s needs. In order to effectively support parents in their role, ROWPH works in collaboration
with many other community organizations to provide supports and services for parents in Waterloo Region. To
ensure that children and families are receiving the most effective supports to meet their needs, it is important to be
aware of the role that ROWPH plays in the system of care and to plan for ways that ROWPH can address gaps in
service.
Overall, in Waterloo Region, there seems to be many programs and services focused on providing positive parenting
messages and skill learning for parents; however, some key elements of a comprehensive approach are missing.
The most significant aspect of a comprehensive approach is coordination among the various supports and services.
This is not occurring in Waterloo Region at present. This may be resulting in gaps between programs, a system that
families find difficult to navigate, and programs which families are not aware of and therefore not accessing. In
addition, some gaps in services were identified both geographically as well as for priority populations in Waterloo
Region that may be better addressed through system-level coordination. Further exploration of unmet needs in
Waterloo Region may also need to occur. In exploring whether evidence-based, comprehensive approaches have
already been developed, there were only two programs that were identified in the literature: Triple P and Incredible
Years. Neither of these programs is being offered in this community, at least not in their complete form. The research
is clear that in order to replicate the outcomes of these programs fidelity must be maintained with some flexibility. If
this community chooses not to introduce either or these programs, there is still much that can be learned from their
effectiveness.
Both practice-based knowledge and evidence was applied to develop a list of priority populations for positive
parenting interventions in Waterloo Region. Local data supported that children living in low income or socially
disadvantaged neighbourhoods are more likely to experience risks for healthy child development. The data also
supports the literature review findings that the early years are a critical time for supporting parents. More exploration
of local data sources is necessary to further support or challenge the priority populations identified through this
process. Further analysis will help to pinpoint more specific populations within the groups of priority populations
identified in Waterloo Region who could benefit most from positive parenting supports.
It is clear from this process that there is eagerness to work together in this community towards a comprehensive
approach to positive parenting. It is hoped that the information contained in this report will contribute to the discussion
of positive parenting in Waterloo Region.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
63
Appendices
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
64
Appendix A
OPHS requirements related to positive parenting
Child Health requirements:
1. The board of health shall conduct epidemiological analysis of surveillance data, including monitoring of
trends over time, emerging trends, and priority populations in accordance with the Population Health
Assessment and Surveillance Protocol, 2008 (or as current), in the areas of:
• Positive parenting;
• Breastfeeding;
• Healthy family dynamics;
• Healthy eating, healthy weights, and physical activity;
• Growth and development; and
• Oral health.
4. The board of health shall work with community partners, using a comprehensive health promotion approach,
to influence the development and implementation of healthy policies and the creation or enhancement of
supportive environments to address:
• Positive parenting;
• Breastfeeding;
• Healthy family dynamics;
• Healthy eating, healthy weights, and physical activity;
• Growth and development; and
• Oral health.
These efforts shall include:
a. Conducting a situational assessment in accordance with the Population Health Assessment and
Surveillance Protocol, 2008 (or as current); and
b. Reviewing, adapting, and/or providing behaviour change support resources and programs.
5. The board of health shall increase public awareness of:
• Positive parenting;
• Breastfeeding;
• Healthy family dynamics;
• Healthy eating, healthy weights, and physical activity;
• Growth and development; and
• Oral health.
These efforts shall include:
a. Adapting and/or supplementing national and provincial health communications strategies; and/or
b. Developing and implementing regional/local communications strategies.
6. The board of health shall provide, in collaboration with community partners, parenting programs, services,
and supports, which include:
a. Consultation, assessment, and referral; and
b. Group sessions.
7. The board of health shall provide advice and information to link people to community programs and services
on the following topics:
• Positive parenting;
• Breastfeeding;
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
65
• Healthy family dynamics;
• Healthy eating, healthy weights, and physical activity;
• Growth and development; and
• Oral health.
8. The board of health shall provide, in collaboration with community partners, outreach to priority populations
to link them to information, programs, and services.
Reproductive Health requirements that are relevant to parenting:
1. The board of health shall conduct epidemiological analysis of surveillance data, including monitoring of
trends over time, emerging trends, and priority populations, in accordance with the Population Health
Assessment and Surveillance Protocol, 2008 (or as current) in the areas of:
• Preconception health;
• Healthy pregnancies;
• Reproductive health outcomes; and
• Preparation for parenting.
2. The board of health shall work with community partners, using a comprehensive health promotion approach,
to influence the development and implementation of healthy policies and the creation or enhancement of
supportive environments to address:
• Preconception health;
• Healthy pregnancies; and
• Preparation for parenting.
These efforts shall include:
a. Conducting a situational assessment in accordance with the Population Health Assessment and
Surveillance Protocol, 2008 (or as current); and
b. Reviewing, adapting, and/or providing behaviour change support resources and programs.
3. The board of health shall increase public awareness of preconception health, healthy pregnancies, and
preparation for parenting by:
a. Adapting and/or supplementing national and provincial health communications strategies; and/or
b. Developing and implementing regional/local communications strategies.
4. The board of health shall provide, in collaboration with community partners, prenatal programs, services,
and supports, which include:
a. Consultation, assessment, and referral; and
b. Group sessions.
5. The board of health shall provide advice and information to link people to community programs and services
on the following topics:
• Preconception health;
• Healthy pregnancies; and
• Preparation for parenting.
6. The board of health shall provide, in collaboration with community partners, outreach to priority populations
to link them to information, programs, and services.
(Standards, Programs & Community Development Branch, Ministry of Health Promotion, 2010, 25-28)24
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
66
Appendix B
Research Methods and Questions Diagram
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
67
Appendix C
The Triple P- Positive Parenting Program Model of Parenting and Family Support
Level
1
1
Triple P
course
Universal
Triple P
Target client group
Professionals who undertake this course
General population targeted through a media-based
parent information strategy
Stay Positive
General population, targeted through a communications
campaign designed to de-stigmatize the concept of
parenting interventions and raise awareness of
parenting issues
Universal Triple P is not a training course. It is a communications strategy
that aims to raise awareness of parenting issues and interventions.
Materials and advice are available to organizations and individual
practitioners to support their efforts to put parenting on the public agenda
Stay Positive is not a training course. It is a fully phased & integrated
communications campaign for regions implementing Triple P. It is usually
coordinated by media staff within the rollout organization
Brief Intervention
2
Selected
Seminars
Triple P
Parents or caregivers interested in general information
about promoting their child’s development
Those involved in education, social services, health services, or voluntary
organizations
2
Selected
Seminars
Teen Triple P
Parents or caregivers interested in general information
about promoting their teenager’s development
Those involved in education, social services, health services, or voluntary
organizations
2
Brief Primary
Care Triple P
Parents or caregivers with a specific concern about
their child’s behavior, seeking an effective brief
strategy. These parents seek an opportunistic one-toone brief consultation
Those who may be involved in opportunistic support for the client and are
only able to provide brief information about an effective strategy, including
school counselors, nurses, home visitors, family physicians, pediatricians,
allied health professionals
2
Brief Primary
Care Teen
Triple P
Parents or caregivers with a specific concern about
their teen’s behavior, seeking an effective brief
strategy. These parents seek an opportunistic one-toone brief consultation
Those who may be involved in opportunistic support for the client and are
only able to provide brief information about an effective strategy, including
nurses, and family physicians
3
Primary Care
Triple P
Parents or caregivers with a specific concern about
their child’s behavior who require one-to-one
consultations and active skills training. These parents
are often unable to commit to regular treatment over
longer periods of time
Those who may be involved in occasional support for the client and are
able to provide focused therapeutic interventions, including nurses, and
family physicians
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
68
Triple P delivery
format
N/A
Includes brochures,
posters, flyers, and
websites. TV,
commercials, radio
spots, billboards,
parent newspapers,
and more
Three 1 ½ -2 hour
seminars delivered to
large groups of parents
(>20)
Three 1 ½ -2 hour
seminars delivered to
large groups of parents
(>20)
One brief individual
consultation (a followup visit or phone call to
review may be
included)
One brief individual
consultation (a followup visit or phone call to
review may be
included)
Several 20-30 min
individual consultations
(possibly 4 sessions
over 1-2 months)
Level
3
Triple P
course
Primary Care
Teen Triple P
3
Primary Care
Stepping
Stones Triple
P
3
Triple P
Discussion
Groups
Intensive Intervention
4
Group Triple P
Target client group
Professionals who undertake this course
Parents or caregivers with a specific concern about
their teen’s behavior who require one-to-one
consultations and active skills training. These parents
are often unable to commit to regular treatment over
longer periods of time
Parents or caregivers of children with a disability (up to
12 years old) with a specific concern about their child’s
behavior who require one-to-one consultations and
active skills training. These parents are unable to
commit to regular treatment over longer periods of time
Parents or caregivers with specific concerns about their
child’s behavior who require a 2-hour group discussion
Those who may be involved in occasional support for the client and are
only able to provide focused therapeutic interventions, including teachers,
school counselors, nurses, home visitors, family physicians, allied health
professionals
Triple P delivery
format
Several 20-30 min
individual consultations
(possibly 4 sessions
over 1-2 months)
Those who may be involved in occasional support for the client and are
only able to provide brief therapeutic interventions, including teachers,
school counselors, nurses, home visitors, family physicians, pediatricians,
allied health professionals
Brief individuals
consultations (possibly
4 x 20-30 min sessions
over 1-2 months)
Those who may be involved in occasional support for the client and are
able to provide brief therapeutic interventions, including teachers, school
counselors, nurses, home visitors, family physicians, pediatricians, allied
health professionals
A 1-session 2 hour
group discussion
Parents or caregivers of children requiring intensive
training in positive parenting or those who wish to learn
a variety of parenting skills to apply to multiple contexts.
These parents can commit to 8 weeks of regular
appointments
Parents or caregivers with concerns about their teen’s
behavior who require intensive training in positive
parenting. These parents can commit to 8 weeks of
regular appointments
Those who are able to provide regular group interventions, including school
counselors, nurses, psychologists, social workers
5 x 2 hr group sessions
+ 3 x 20 min individual
telephone consultations
for a group of up to 12
parents of children
5 x 2 hr group sessions
+ 3 x 20 min individual
telephone consultations
for a group of up to 12
parents of teens
6 x 2 ½ hr group
sessions + 3 x 20 min
individual telephone
consultations for a
group of up to 12
parents of children
10 individualized 1 hr
weekly sessions
4
Group Teen
Triple P
4
Group
Stepping
Stones Triple
P
Parents or caregivers of children with a disability (up to
12 years of age) requiring intensive training in positive
parenting or those who wish to learn a variety of
parenting skills to apply to multiple contexts. These
parents can commit to 9 weeks of regular appointments
Those who are able to provide regular group interventions, including school
counselors, nurses, psychologists, social workers
4
Standard
Triple P
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, allied
health professionals
4
Standard Teen
Triple P
Parents or caregivers with concerns about their child’s
behavior who require intensive training in positive
parenting. These parents can commit to 10 weeks of
regular appointments
Parents or caregivers with concerns about their teen’s
behavior who require intensive training in positive
parenting. These parents can commit to 10 weeks of
regular appointments
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
Those who are able to provide regular group interventions, including school
counselors, nurses, psychologists, social workers
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, allied
health professionals
69
10 individualized 1 hr
weekly sessions
Level
Triple P
course
4
Standard
Stepping
Stones Triple
P
Adjunctive support
5
Group
Lifestyle Triple
P
5
Family
Transitions
Triple P
5
Enhanced
Triple P
5
Pathways
Triple P
Target client group
Professionals who undertake this course
Parents or caregivers of children with a disability (up to
12 years of age) who have moderate to severe
concerns about their child’s behavior and are able to
commit to 2 months of regular appointments
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, and
allied health professionals
Parents or caregivers of overweight or obese children
(5-10 years of age) who are concerned about their
child’s weight and are willing to make changes in their
family’s lifestyle. These parents can commit to up to 6
months or regular appointments
Parents going through separation and divorce who
have concurrent concerns about their child’s behavior
Those who are able to provide regular group interventions, including
dieticians, physical education teachers, nurses, psychologists, physicians
Parents of children with concurrent child behavior
problems and family adjustment difficulties, e.g.
parental depression or stress and partner conflict.
These parents have attempted a Level 4 program and
shown minimal improvements
Parents who have anger management issues and other
issues that put them at risk of child abuse and neglect
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, and
allied health professionals
10 1 ½ hr group
sessions + 4 x 20 min
telephone consultations
for a group of up to 10
families
5 x 2 hr individual or
group sessions in
addition to Group,
Group Teen, or Group
Stepping Stones Triple
P
3 -10 individualized 6090 min parenting
sessions
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, and
allied health professionals
2-5 individualized or
group 60-90 min
sessions
Those who are able to provide individualized regular interventions,
including school counselors, nurses, psychologists, social workers, and
allied health professionals
Source: Triple P Parenting Canada. (2011). The Triple P System. Retrieved from Debbie Easton, December 2011.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
Appendix D
70
Triple P delivery
format
10 individualized 1 ½ hr
weekly sessions
Canadian Best Practices Portal Search Summary
Name of
Intervention
Summary of research
Age range
Early Start
Research evaluation has been built into each stage of the Early Start program development to evaluate the extent to which a home visitation
program has had beneficial consequences for child health, preschool education, service utilization, parenting, child abuse and neglect, and
behavioural adjustment. Families who have participated in the Early Start program have shown significant benefits in a wide range of areas.
0-2
Family
Connections
Findings from research on Family Connections lend support to other studies of home-based interventions with high-risk families. In general,
participants reported positive changes in their family and circumstances, with several of these gains being sustained six months after the intervention
had ended.
Healthy
Beginnings
Enhanced
Home Visiting
Healthy
Families
America
The DADS
Project
Triple P –
Positive
Parenting
Program
Families and
Schools
Together
(FAST)
Population addressed in the
intervention faces the following
risks:

Low income
3-5,
13-17



Extreme poverty
Unemployed
Being a single parent
The Phase III evaluation of the Healthy Beginnings Enhanced Home Visiting program found that the program improved all aspects of the short term
outcomes being assessed, which was enhanced capacity of families to support healthy child development which encompasses: increased
confidence, knowledge, and skills regarding parenting and care of infants and young children; reduced parental stress; and increased use of
available supports. The mid-term outcomes were also positively affected by the intervention; parents were performing more supportive parenting
practices, which included enhanced parent-child interaction, using positive and age appropriate discipline strategies, increased home literacy
activities, ensuring a safe environment for their children including keeping them away from second-hand smoke, and increased preventive health
practices such as healthy eating. The evaluation also found that the program was helping parents to achieve their own goals.
A randomized control trial was designed to evaluate the effectiveness of Healthy Families New York (HFNY). Specifically, it looks at HFNY's ability to
reduce child abuse and neglect with a focus on the importance of pre- versus post-natal service delivery. The key findings of the study suggest that
who is offered home visitation is an important factor in determining the effectiveness of home visitation programs and that improved impacts may be
realized by prioritizing the populations served or by enhancing the model to meet program objectives for hard-to-serve families.
Neo-natal,
0-2

May face challenges pertaining to
income, education, food security,
mental health, social isolation,
among others
Prenatal,
neo-natal



An evaluation of the program was completed with fathers who were incarcerated in a state prison system. A standardized questionnaire and
structured interviews were used to assess participants' experience of the training.
Findings show that the program had a positive influence on the participants' attitudes about fathering.
There have been a large number of evaluations completed on the Triple P intervention, focusing on the different levels of the intervention, as well as
different modes of delivery. The evaluations tend to report large effect sizes in treatment outcomes, with good maintenance of treatment gains, and
high levels of participant satisfaction. Evaluations of the Triple P have consistently shown positive effects on observed and parent-reported child
behaviour problems, parenting practices, and parents' adjustment across sites, investigators, family characteristics, cultures and countries.
No age range
for children
specified
Neo-natal
0-2,
3-5,
6-12,
13-17

Low income
Not completed high school
“Psychologically vulnerable” –
based on mental health status,
mastery, and a measure of limited
intellectual functioning
Incarcerated fathers
FAST has undergone several evaluations in both the United States and in Canada. These evaluations indicate that the program is effective at
improving children's social skills, decreasing externalizing behaviours, improving academic performance, and decreasing referrals to special
education. It is also associated with improvements in family adaptability and parents’ feelings of social isolation.
6-12


Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
71
No information available
Low income
Children who exhibit multiple risk
factors that put them at risk for
future academic and social
problems
Name of
Intervention
Summary of research
Age range
Better
Beginnings,
Better Futures
Project
Better Beginnings, Better Futures is one of the most ambitious Canadian research projects on the long-term impacts of early childhood prevention
programming for children and their families living in disadvantaged neighbourhoods. The Better Beginnings, Better Futures model is designed to
prevent young children in low income, high risk neighbourhoods from experiencing poor developmental outcomes, which then require expensive
health, education and social services or interventions. The Better Beginnings model consisted of programs that are delivered at three levels:
• Child-focused programs that enriched children’s social and academic environments
• Parent- and family-focused programs that provided parent support and parenting education
• Community-focused programs that worked to improve conditions such as neighbourhood safety and cohesion.
The Better Beginnings, Better Futures project was initiated by the Ontario government in 1990. Since 1991, the Better Beginnings model has been
implemented in 8 socio- economically disadvantaged communities in Ontario. The focus of this annotation is on the 3 sites that offered programs for
children between the ages of 4 to 8 years old.
3-5
6-12
Optimism and
Lifeskills
Program
The purpose of this study was to examine the effectiveness of the Optimism and Lifeskills Program (i.e. a modified Penn Depression Prevention
Program) for preventing depression in preadolescent girls of ages between 11 and 12 years who were completing their last year of primary school at
a private girls school located in a high socio-economic suburb of Perth, Western Australia. This study links to the systematic review evidence
provided in the following article: Horowitz JL., Garber J. The Prevention of Depressive Symptoms in Children and Adolescents: A Meta-Analytic
Review. Journal of Consulting and Clinical Psychology 2006; 74(3): 401-415. The results of this study indicate that the intervention group reported
significantly fewer depressive symptoms and significantly higher self-worth at six month follow-up when compared with the control group. There were
no significant differences between intervention and control groups found in attributional style or in the amount of loneliness reported at postintervention and at six month follow-up. While this study looked at the impact specifically on females, the programs have been used with both
genders.
The Seattle Social Development Project (SSDP) began in 1981 to test strategies for reducing childhood risk factors for school failure, drug abuse,
and delinquency. First graders in five Seattle schools were assigned to intervention or control classrooms. Each year through the elementary grades,
parents and teachers in intervention classrooms learned how to actively engage children in learning, strengthen bonding to family and school, and
encourage children's positive behaviors. The program consisted of yearly parent and teacher training; student social influences/social competency
training provided in grades one through six. In 1985, when the original first graders entered the fifth grade, the panel was expanded to 808 students
from 18 Seattle elementary schools and the same intervention was provided.
Observed program effects included positive effects on students’ sense of the school as a community and other school-related attitudes and motives
(e.g., liking for school, achievement motivation); social attitudes, skills, and values (e.g., concern for others, conflict resolution skill, commitment to
democratic values); and involvement in problem behaviours (i.e., reduced use of alcohol and marijuana, and less participation in some forms of
delinquency, including violent behaviours such as “gang fighting”). The follow-up study showed continuation of positive effects but for alcohol and
marijuana use, program effects that were observed during elementary school were not found during follow-up in middle school.
Evaluations have demonstrated both short- and long-term gains for youths receiving the intervention. At age 12, three years after the intervention,
treated boys were less likely to report the following offenses: trespassing, taking objects worth less than ten dollars, taking objects worth more than
ten dollars, and stealing bicycles. Treated boys were rated by teachers as fighting less often than untreated boys, more well-adjusted, they displayed
less serious difficulties in school, and fewer were held back or placed in special education classes. At age 15, those receiving the intervention were
less likely than untreated boys to report gang involvement, having been drunk or taken drugs in the past 12 months, having committed delinquent
acts (stealing, vandalism, drug use), and having friends arrested by the police.
6-12
Low income
Unemployed
Not completed high school
Not fluent in English
Access to affordable, nutritious
food
 Access to housing – affordability,
quality, homelessness, street life
 Being a single parent
 Access to quality affordable child
care
 Access to affordable recreation
activities
 Low levels of community safety
 Unhealthy child development
No information available
6-12
Not available
6-12
Not available
6-12
Low income
Seattle Social
Development
Project
Child
Development
Project
Preventive
Treatment
Program
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
72
Population addressed in the
intervention faces the following
risks:





Name of
Intervention
Summary of research
Age range
Nobody’s
Perfect
Is a parenting education and support program for parents of children from birth to age five. It is designed to meet the needs of parents who are
young, single, socially or geographically isolated or who have low income or limited formal education. Participation is voluntary and free of charge.
Neo-natal
0-2
3-5
13-17
RETHINK
Parenting and
Anger
Management
Program
Incredible
Years
Strengthening
Families for
the Future
RETHINK is a parenting and anger management program that teaches parents about child development and anger mismanagement that can lead to
child mistreatment. The goal is to help parents recognize personal anger, address underlying causes and triggers, and identify alternate channels of
expression to manage anger issues constructively. Four key components of the RETHINK training include anger management, child abuse
prevention, child development, and parenting skills. Due to limited empirical research on the effectiveness of child abuse prevention programs that
focus on parents and their anger management, an evaluation of behavioural, social, and emotional results was undertaken. The findings suggest
that programming for parents that aims to include anger management skills, and comprehensive cognitive and behavioural skill building, can be
effective in reducing parents' mismanaged anger and risk of child mistreatment.
The Incredible Years: Parents, Teachers, and Children Training Series is a comprehensive set of curricula designed to promote social competence
and prevent, reduce, and treat aggression and related conduct problems in babies, toddlers, young children, and school-aged children. The
interventions that make up this series—parent training, teacher training, and child training programs are guided by developmental theory concerning
the role of multiple interacting risk and protective factors (child, family, and school) in the development of conduct problem.
Strengthening Families for the Future is a prevention program for families with children between the ages of seven and 11 who may be at risk for
substance use problems, depression, and violence, delinquency and school failure. Strengthening Families is effective because it involves the whole
family.
0-2
3-5
6-12
13-17
Population addressed in the
intervention faces the following
risks:








Also mentions that First Nations, Metis
or Inuit populations are a priority
Not available
0-2
3-5
6-12
Not available
6-12
Children who may be at risk for
substance abuse, depression, violence,
delinquency and school failure
(Adapted from Source: Public Health Agency of Canada (2011). Canadian Best Practices Portal. Targeted search results. http://cbpp-pcpe.phac-aspc.gc.ca/intervention/findTargeted Accessed April 29, 2011).
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
73
Low income
Unemployed
Job insecure
Not completed high school
Not fluent in English
Not fluent in French
Being a single parent
Access to quality affordable child
care
Appendix E
Positive Parenting Community Inventory Survey
Region of Waterloo Public Health is conducting a scan of Positive Parenting initiatives being delivered across
Waterloo Region. This is intended to be a snapshot of what is currently available in the community and will not be
updated. We have developed a Positive Parenting Community Inventory Survey to assist us with this process, and
would appreciate your participation in this survey. If you choose not to participate in the survey it will not affect the
services that you presently receive from Region of Waterloo Public Health. However, your answers will help us to
develop comprehensive action plans to address Positive Parenting programs and services in Waterloo Region.
The survey should take approximately 10 minutes to complete for each Positive Parenting initiative in your
organization. The information collected from this survey will be shared within Region of Waterloo Public Health and
with our partners on the Positive Parenting Community Committee. A summary of results will also be available for
participants, should they request one.
If you have any questions or concerns about this survey, please contact Erin Tardiff, Public Health Planner, at
etardiff@regionofwaterloo.ca or 519-883-2002 ext 5384, or Sharmin Jaffer, Manager of Child and Family Health
Promotion, at sjaffer@regionofwaterloo.ca or 519-883-2003 ext. 5135.
On behalf of Region of Waterloo Public Health, I would like to thank you in advance for your participation in this
survey.
Organization name: pre-filled
Contact name: pre-filled
Contact email: pre-filled
Website: pre-filled
1. If the information above is incomplete and/or inaccurate please provide the correct information about your
organization:
Organization name:
_____________________________________________________
Street address:
_____________________________________________________
City:
_____________________________________________________
Postal code:
_____________________________________________________
Website:
_____________________________________________________
Contact name:
_____________________________________________________
Contact email:
_____________________________________________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
74
For the following questions, please use these two definitions to help you respond:
Positive parenting:
For the purpose of this Public Health project, our working definition of ‘positive parenting’ comes from the Ontario
Public Health Standards guidance document:
Positive parenting is defined as “Positive/warm and consistent parenting interactions with the child ([i.e.] parents
frequently talking, playing, praising, laughing, and doing special things together with their children, [setting] clear and
consistent expectations, and [using] non-punitive consequences with regard to child behaviour)” (Standards,
Programs & Community Development Branch, Ministry of Health Promotion, 2010, 19)
Activity:
Any planned process linked to resources and intended to achieve a change or outcome in an intended population; an
activity can have one or more than one component and more than one strategy. An example of an activity with one
component could be a parent education seminar on positive parenting. An example of an activity with more than one
component would be a breastfeeding strategy that includes advocacy, policy development, and promotional
components.
2. Does your organization lead any positive parenting activities (please include
involvement in provincial or national campaigns)?
Y
N
(If no, survey ends)
3. Who is involved in planning and/or leading any of the positive parenting activities at
your organization? (Check all that apply)
Community Member
Community Worker
Early Childhood Educator
Nurse
Nutritionist
Psychologist/Psychiatrist
Social Worker
Teacher
Other
If other, please list_________________________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
75
4. If positive parenting activities are offered at locations other than your main site
(address already provided), please list addresses of these additional locations:
Organization name:
Street address:
City:
Postal code:
___________________________________
___________________________________
___________________________________
___________________________________
4.a Are your positive parenting activities offered at any other locations?
Y
N
(skip pattern)
4.b
Organization name:
Street address:
City:
Postal code:
___________________________________
___________________________________
___________________________________
___________________________________
(skip pattern #4a &$4b repeat)
You will now be asked a series of questions about each positive parenting activity your organization leads.
Please take a moment to think about the number of positive parenting activities your organization leads.
5. What is the name of the positive parenting activity?
_________________________________________________________________
6. Which of the following elements does the positive parenting activity address?
(Check all that apply)
Warm or nurturing parenting (i.e. parents frequently talking, playing, praising, laughing and doing special
things together with their children)
Setting clear and consistent expectations or boundaries
Using praise for reinforcement of positive behaviours
Using non-punitive consequences for negative behaviours
Practicing a child-centred approach
Encouraging independence while maintaining monitoring behaviours
Other ____________________________________________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
76
7. Which of the following strategies does your positive parenting activity include?
(Check all that apply)
Social marketing and/or health communication (e.g. media campaign) (skip pattern to #7a)
Self-help, mutual aid, or peer approaches (e.g. support group)
Group parent education or parent training program
Individual parent education or parent training program
Advocacy
Policy development
Multidisciplinary approach
Other_____________________________________________________
7a. What types of media did your social marketing and/or health communication (media) campaign use? (Check all
that apply)
Pamphlets, posters, billboards, newspapers ads, etc.
Television
Radio
Email
E-newsletter
Twitter
Facebook
Blog
Other, please specify _______________________
8. Please indicate if the positive parenting activity is (Check only one):
Open to everyone (Universal)
Both (Universal and targeted)
Only open to certain groups (Targeted)
Not Applicable
(Skip pattern - If Targeted or both universal and targeted, skips to 8a.)
8a .Please indicate the populations that you target (e.g. young parents,
parents living with low income, parents of children with developmental
disabilities, etc):
___________________________________________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
77
9. Your positive parenting activity is geared towards parents of what age range of
children? (Check all that apply)
Prenatal
0-3 years
4-7 years
8-12 years
13-18 years
Not Applicable
10. Is there a cost to the participant(s) for the positive parenting activity?
(Check only one)
Fee; subsidy available
Fee; no subsidy available
No fee
Not Applicable
11. Do you collaborate on this positive parenting activity with other organizations?
Y
N
(skip pattern)
11a. If yes, please list:
________________________________________
12. What informed the development of the positive parenting activity?
(Check all that apply)
An existing program that has NOT been evaluated
An existing program that HAS been evaluated
Client need (community input)
Client need (staff input)
Client need (data identified)
Staff experience of activity delivery
Literature review and research studies
Unsure
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
78
13. Has your organization evaluated the positive parenting activity?
(Note: This could be completed in partnership with a university, with outside
consulting support, etc.)
Y
N
(If no, survey skips to #16)
14. Which of the following types of evaluation were conducted on the positive parenting
activity? (Check all that apply)
The activity met participants’ expectations (Client satisfaction)
The activity happened as planned (Process)
The activity changed what it was meant to (Outcome)
Unsure
15. If you are able to share the report or results in greater detail, please upload the document
Upload procedure provided
15.a If you are not able to upload the document(s) at this time, who should we contact about receiving a copy?
(Please provide contact information if the contact person is someone other than yourself).
16. Does your organization lead any additional positive parenting activities?
Y
(if yes, questions #5-16 repeat)
N
(Survey stops repeating)
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
79
At the end of the 20th activity (only if an organization fills in the survey for 20 separate activities) the following message will
appear:
If your organization has more than 20 positive parenting activities, please contact Erin Tardiff at
etardiff@regionofwaterloo.ca or at 519-883-2002 x 5384 for how to complete.
17. Would you like to receive a summary of the results of this survey?
Y
N
18. Do you have any other comments about the positive parenting activities at your
organization, or about this survey?
Thank you for taking the time to complete this survey! Your responses will help with planning for programs
and services for children and youth in Waterloo Region.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
80
Appendix F
Public Health Unit Survey
Public Health Unit Positive Parenting Survey
Region of Waterloo Public Health is currently conducting a scan of the positive parenting activities presently
being done by Public Health units across Ontario The information collected from this scan will be shared
within Region of Waterloo Public Health and will help inform the planning of programs and services that
address positive parenting in our community. A summary of the scan will be available to all Public Health
units who participate.
The survey should take you approximately 20 minutes to complete. We may want to follow up with your
organization in the future if we require more in depth information to your survey responses. We do ask your
permission first to contact you for more information.
If you have any questions or concerns about this survey, please contact Erin Tardiff, Public Health Planner,
at etardiff@regionofwaterloo.ca or 519-883-2002 ext 5384, or Sharmin Jaffer, Manager of Child and Family
Health Promotion, at sjaffer@regionofwaterloo.ca or 519-883-2003 ext. 5135.
On behalf of Region of Waterloo Public Health, I would like to thank you in advance for your participation in
this survey.
1. Please provide the following information about your Public Health unit:
Organization name:
_____________________________________________________
Contact name: _____________________________________________________
Contact position: _____________________________________________________
Contact email:
_____________________________________________________
2. What definition of positive parenting do you use at your Public Health unit?
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
81
3. Which Ontario Public Health Standards requirements do your positive parenting activities address?
Check all that apply.
CH Req 1. (Epidemiology)
CH Req 4. (Working with community partners, comprehensive health promotion approach,
supportive environment and policy development)
CH Req 5. (Increase public awareness of positive parenting)
CH Req 7. (Provide advice and info to link people to positive parenting programs and
services)
Unsure
Other, please specify________________________
Please use this definition of activity to help you respond to the questions about positive parenting activities.
Activity: Any planned process linked to resources and intended to achieve a change or outcome in an intended
population; an activity can have one or more than one component and more than one strategy. An example of an
activity with one component could be a parent education seminar on positive parenting. An example of an activity
with more than one component would be a parenting education campaign that includes advocacy, policy
development, and promotional components.
4. What are the titles of the positive parenting activities led in your Public Health unit?
Please list all that apply.
1________________________
2________________________
3________________________
4________________________
5________________________
6_______________________
7________________________
8________________________
9________________________
10________________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
82
5. Thinking about all of the positive parenting activities that you listed, please check which of the following describes
the population that the activity targets:
Check all that apply.
Activity
Universal
Targeted
Activity
Activity
(e.g.
priority
population)
Both
Universal
and
Targeted
Prenatal
0-3
4-8
9-12
13-18
Activity 1








Activity 2








Activity 3








Activity 4








Activity 5








Activity 6








Activity 7








Activity 8








Activity 9








Activity 10








6. Does your Public Health unit have more than 10 positive parenting activities?
Y
N
(skip pattern - If yes, skip to 6a and 6b)
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
83
6.a What are the titles of the positive parenting activities led in your Public Health unit?
Please list all that apply.
11________________________
12________________________
13________________________
14________________________
15________________________
16_______________________
17________________________
18________________________
19________________________
20________________________
6.b Thinking about all of the positive parenting activities that you listed, please check which of the following describes
the population that the activity targets:
Check all that apply.
Activity
Universal
Targeted
Activity
Activity
(e.g.
priority
population)
Both
Universal
and
Targeted
Prenatal
0-3
4-8
9-12
13-18
Activity 11








Activity 12








Activity 13








Activity 14








Activity 15








Activity 16








Activity 17








Activity 18








Activity 19








Activity 20








Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
84
7. If any of your activities are targeted to priority populations, please tell us which priority populations? If you do not have
any targeted activities, please type "N/A".
8. Considering all of the positive parenting activities at your Public Health unit, which of the following strategies are
used? (Check all that apply)
□
□
□
□
□
□
□
□
Social marketing and/or health communication (e.g. media campaign) (skip pattern to q#8)
Self-help, mutual aid, or peer approaches (e.g. support group)
Group parent education or parent training program
Individual parent education or parent training program
Advocacy
Policy development
Multidisciplinary approach
Other_____________________________________________________
8a. Which of the following types of social marketing and/or health communication strategies does your Public Health
unit use? (Check all that apply)
Pamphlets, posters, billboards, newspapers ads, etc.
Television
Radio
Email
E-newsletter
Twitter
Facebook
Blog
Other, please specify _______________________
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
85
9. Consider all of the positive parenting activities that your Public Health unit leads. For those that have a face-to-face
element to them, are they offered at different sites across your community?
Y
N
10. Consider all of the positive parenting activities that your Public Health unit leads, do you collaborate with other
organizations to lead them?
Y
N
11. Has your Public Health unit evaluated any of the positive parenting activities?
Y
N
(if no skip to question #15)
12. Which of the following types of evaluation were conducted on the positive parenting
activity? (Check all that apply)
□ Client satisfaction
□ Process
□ Outcome
□ Unsure
13. Are you able to share the evaluation report or summary of findings?
Y
N
(if no skip to question #15)
14. If you are able to share the report or summary of findings, please upload the document(s)
Upload procedure provided
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
86
15. If you are not able to upload the document(s) at this time, who should we contact about receiving a copy?
Contact name:__________________________
Contact email:__________________________
16. What lessons have been learned at your Public Health unit from implementing positive parenting activities?
Please share any tips for what worked well and/or what didn’t work well.
17. Do you have any other comments about the positive parenting activities at your Public Health unit or about this
survey?
18. Can we contact you if we have any questions about the responses that you provided or would like more in depth information?
Y
N
Thank-you for taking the time to complete this survey! Your responses will help with planning for programs
and services for children and youth in Waterloo Region.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
87
Appendix G
Explanation of NESI score
“A Neighbourhood Economic Security Index (NESI), based on the Understanding the Early Years Social Index
(Connor, 2001) and the Vision for Halton Report’s Economic Security Index (Our Kids Network, 2004), was
constructed to reveal economic conditions of neighbourhoods in Waterloo Region. The scores for all six economic
indicators (income, employment, housing type and affordability, education, and family structure) were added together
to form a summary score. A score of zero indicates that a neighbourhood has fewer families dealing with economic
challenges than other neighbourhoods in the Region. A higher score on the NESI indicates that a greater number of
families living in the neighbourhood are facing significant economic challenges; they may have higher rates of
unemployment, lower income, lower levels of education, or may be spending a higher percentage of their income on
housing costs relative to other areas in Waterloo Region” (Tardiff, 2009, 6). 176
The following variables from the 2006 Census are included in the index:
1. Unemployment rate
→ percentage of unemployed people, 15 years or older
2. Low income families
→ percentage of families with low income before tax ad defined by the Low Income Cutoff (LICO
threshold of Statistics Canada
3. Education
→ percentage of people, aged 25-64 years old, without high school diploma
4. Family structure
→ percentage of lone-parent families
5. Rental housing
→ percentage of private residential dwellings that are rented/not owned
6. Home spending
→ percentage spending more than 30 per cent of income on housing costs176
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
88
Appendix H
Lessons Learned
Question: What lessons have been learned at your Public Health Unit (PHU) from implementing positive parenting
activities? Please share any tips for what worked well and/or what didn’t work well.
Themes and descriptions
Community partners/Collaborative Approach
The most prominent theme in the responses was working with community partners in planning and delivering positive
parenting initiatives. Seven of eight responses touched on this theme. Different PHUs touched on different
considerations when working with community partners. Lessons learned included that:
o Community partners help local public health units to:
o disseminate resources and main, consistent messages
o share workload (delivering presentations and key messages) and resources
o Access target populations or universal populations
o Use of one program has enhanced community collaboration and knowledge base
o Need to collaborate internally as well as externally
Target Group
Several PHU shared lessons learned in regards to target groups for positive parenting activities. These lessons
included defining the target population in the planning stage, being patient, budgeting appropriate funds, and to work
with community partners to reach target populations.
•
•
•
•
•
•
“Defining the target group/audience before implementing the program is essential.”
“With our neighbourhood groups, have needed to be patient as the program builds its participation numbers. It
takes a year to have a good solid base.”
“We have also used our relationships with various community partners to have access to our targeted programs
while relying on our relationships with OEYCs for much of the universal in the early years”
“Budget appropriately including cost for Diversity and Access”
“Try to have staff that speak the language facilitate language specific groups”
“Be flexible with time/session with clients that English is a second language and teen parents”
Skill development for those delivering service
PHUs also shared the importance of continuing training for both people delivering the programs: both Public Health
Nurses and community partners.
Two PHUs highlighted the importance of interactive training.
•
•
“Staff must have ongoing/ interactive training in regards to positive parenting in order to transfer knowledge to
practice (including positive parenting case discussions at team meetings has been useful).”
“When training staff, build on competences and allow opportunity for practice sessions at the training"
Two PHUs noted that training their community partners helped to deliver their key messages and programs:
•
“Train the trainer sessions with internal staff and community partners have also worked well to ensure
consistent messaging.”
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
89
•
“Many of our community partners are well positioned and skilled to present parenting presentations with
appropriate training and support from Public Health.”
One PHU cited that Triple P, “has been very helpful to use the materials and structure of the program to enhance
PHN practice in various settings”.
Strategy elements
PHUs shared their learning about what elements of positive parenting strategies seem to work best. Some of the
suggestions that were discussed included:
o There needs to be structure to the program
o Activities should be based on strong evidence
o Need to build on success
o Brief strategies seem to have the furthest reach
o A blend of activities works best
o Need to build in evaluation
Funding
Considerations about funding came up several times from PHUs sharing lessons learned. Comments touched on
what to invest in, how to do more with less and budgeting considerations.
•
•
•
“Seek sustainable funding; Invest resources in programs that work and have clear evidence; Build on
successes”
“We have used a community collaboration in many of our activities and this works well to share workload and
resources.”
“Budget appropriately including cost for Diversity and Access”
Removing barriers to engagement
Suggestions were made for how to reduce the barriers that some members of the community may face in engaging
in positive parenting activities. Comments from the different health units describe different strategies to consider
when trying to engage populations who may experience barriers to accessing parenting interventions. Themes in the
comments include:
o Diversity and Access
o Flexibility
o Not all parents need the same type of intervention
•
•
•
•
“Try to have staff that speak the language facilitate language specific groups”
“Be flexible with time/session with clients that English as a second language and Teen parents”
“Parents find what works for them and it isn't always the same”
“With our neighbourhood groups, have needed to be patient as the program builds its participation numbers”
Contradictory feedback
One PHU spoke of the virtues of having one program (Triple P- Positive Parenting Program), “We have been able to
enhance community collaboration by using a consistent program among agencies… It has been easier to establish
common language and materials”, whereas another PHU advises that, “a blend of activities works better than one
program” as “Parents find what works for them and it isn’t always the same”.
Source: ROWPH (2011). Positive Parenting Public Health Unit Survey. Extracted August, 2011.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
90
Endnotes
1
Queen’s Printer for Ontario. (2008). Glossary for the Ontario Public Health Standards. Accessed November 3, 2011 at:
http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/glossary.html
Wade, S. L., Oberjohn, K., Burkhardt, A., and Greenberg, I. (2009). Feasibility and preliminary efficacy of a web-based
parenting skills program for young children with traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(4), 239-247.
2
Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger-Gagne, M., Girio, E. et al. (2009). Enhancing traditional
behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 38(2),
206-218.
3
Mazzucchelli, T. G., and Sanders, M. R. (2010). Facilitating practitioner flexibility within an empirically supported intervention:
Lessons from a system of parenting support. Clinical Psychology: Science & Practice, 17(3), 238-252.
4
Sanders, M., Calam, R., Durand, M., Liversidge, T., and Carmont, S. A. (2008). Does self-directed and web-based support for
parents enhance the effects of viewing a reality television series based on the triple P – positive parenting programme? Journal
of Child Psychology & Psychiatry, 49(9), 924-932.
5
Hourihan, F., and Hoban, D. (2004). Learning, enjoying, growing, support model: An innovative collaborative approach to the
prevention of conduct disorder in preschoolers in hard to reach rural families. Australian Journal of Rural Health, 12(6), 269-276.
6
Lipscombe, J., Farmer, E., and Moyers, S. (2003). Parenting fostered adolescents: Skills and strategies. Child & Family Social
Work, 8(4), 243.
7
Durham Region Health Department (2008. Positive Parenting: For the well-being of our children. Parent-child interaction in
Durham Region. www.region.durham.on.ca Accessed April 2011.
8
Turner, K.M.T., and Sanders, M.R. (2006). Dissemination of evidence-based parenting and family support strategies: Learning
from the Triple P- Positive Parenting Program system approach. Aggression and Violent Behavior, 11, 176-193.
9
Whittaker, J. E. V., Harden, B. J., See, H. M., Meisch, A. D., and Westbrook, T. (2011). Family risks and protective factors:
Pathways to early head start toddlers’ social–emotional functioning. Early Childhood Research Quarterly, 26(1), 74-86.
10
Dittus, P., Miller, K. S., Kotchick, B. A., and Forehand, R. (2004). Why parents matter!: The conceptual basis for a communitybased HIV prevention program for the parents of African American youth. Journal of Child & Family Studies, 13(1), 5-20.
11
Sanders, M. R. (2008). Triple P-positive parenting program as a public health approach to strengthening parenting. Journal of
Family Psychology, 22(4), 506-517.
12
Lunkenheimer, E. S., Shaw, D. S., Gardner, F., Dishion, T. J., Connell, A. M., and Wilson, M. N. (2008). Collateral benefits of
the family check-up on early childhood school readiness: Indirect effects of parents' positive behavior support. Developmental
psychology, 44(6), 1737-1752.
13
Bosmans, G., Braet, C., Leeuwen, K., and Beyers, W. (2006). Do parenting behaviors predict externalizing behavior in
adolescence, or is attachment the neglected 3rd factor? Journal of Youth & Adolescence, 35(3), 354-364.
14
Lundahl, B., Risser,H.J., and Lovejoy, M.C. (2006). A meta-analysis of parent training: Moderators and follow-up effects.
Clinical Psychology Review, 26, 86-104.
15
Invest in Kids (2010). Positive Parenting. http://www.investinkids.ca/parents/positive-parenting.aspx Accessed February 25,
2010.
16
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
91
McTaggart, P., and Sanders, M.R. (2007). Mediators and moderators of change in dysfunctional parenting in a school-based
universal application of the triple-P positive parenting programme. Journal of Children’s Services, 2(1), 4-17).
17
Sanders, M. R., Prior, J., and Ralph, A. (2009). An evaluation of a brief universal seminar series on positive parenting: A
feasibility study. Journal of Children's Services, 4(1), 4-20.
18
Ralph, A., and Sanders, M. R. (2004). The 'teen triple P' positive parenting program: A preliminary evaluation. (cover story).
Trends & Issues in Crime & Criminal Justice, (282), 1-6.
19
Belsky, J. (2005). Social-contextual determinants of parenting. In: Tremblay, R.E., Barr, R.G., and Peters, RDeV, eds.
Encyclopedia on Early Childhood Development [online]. Montreal, Quebec: Centre of Excellence for Early Childhood
Development; 2005: 1-6. Available at : http://www.child-encyclopedia.com/documents/BelskyANGxp-Parenting.pdf. Accessed
April 2011.
20
21 Centre for Addiction and Mental Health (2011). Tips for parents on building health relationships with their teenagers – From Dr.
David Wolfe, RBC Investments Chair in Children’s Mental Health & Development Psychology.
http://www.camh.net/about_addiction_mental_health/tips_for_parents_teens.html Accessed April 27, 2011.
Kopko, K. and Dunifon, R. (2010). What’s new: parenting and adolescent development. http://www.parenting.cit.cornell.edu
Accessed April 2011.
22
23
Ralph, A. and Sanders, M. (2006). The ‘Teen Triple P’ Positive Parenting Program. Youth Studies Australia, 25(2), 41-48.
Standards, Programs & Community Development Branch, Ministry of Health Promotion. (2010). Child Health
Guidance Document. May 2010. http://www.mhp.gov.on.ca/en/healthy-communities/public-health/guidancedocs/ChildHealth.pdf Accessed January 10, 2011.
24
Johnson, M. A., Stone, S., Lou, C., Ling, J., Claassen, J., and Austin, M. J. (2008). Assessing parent education programs for
families involved with child welfare services: Evidence and implications. Journal of Evidence-Based Social Work, 5(1), 191-236.
25
McVittie, J., and Best, A. M. (2009). The impact of alderian-based parenting classes on self-reported parental behavior. The
Journal of Individual Psychology, 65(3), 264-285.
26
Vasquez, M., Meza, L., Almandarez, O., Santos, A., Matute, R. C., Canaca, L. D. et al. (2010). Evaluation of a strengthening
families (familias fuertes) intervention for parents and adolescents in honduras. Southern Online Journal of Nursing Research,
10(3) 13p.
27
Leung, C., Tsang, S., Heung, K., and Yiu, I. (2009). Effectiveness of Parent—Child interaction therapy (PCIT) among chinese
families. Research on Social Work Practice, 19(3), 304-313.
28
Dougherty, D. (1993). Major policy options from a report to congress on adolescent health. Journal of Adolescent Health,
14(7), 499-504.
29
Jarvis, C., Trevatt, D., and Drinkwater, D. (2004). Parenting teenagers: Setting up and evaluating a therapeutic parent
consultation service: Work in progress. Clinical Child Psychology and Psychiatry, 9(2), 205-225.
30
Cripps, K., and Zyromski, B. (2009). Adolescents psychological well-being and perceived parental involvement: Implications for
parental involvement in middle schools. Research in Middle Level Education Online, 33(4), 1-13.
31
Castrucci, B. C., and Gerlach, K. K. (2006). Understanding the association between authoritative parenting and adolescent
smoking. Maternal & Child Health Journal, 10(2), 217-224.
32
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
92
Kitzman-Ulrich, H., Wilson, D. K., St George, S.,M., Lawman, H., Segal, M., and Fairchild, A. (2010). The integration of a
family systems approach for understanding youth obesity, physical activity, and dietary programs. Clinical child and family
psychology review, 13(3), 231-253.
33
Stemmler, M., Beelmann, A., Jaursch, S., and Lösel, F. (2007). Improving parenting practices in order to prevent child
behavior problems: A study on parent training as part of the EFFEKT program. International Journal of Hygiene & Environmental
Health, 210(5), 563-570.
34
Stolk, M. N., Mesman, J., van Zeijl, J., Alink, L. R. A., Bakermans-Kranenburg, M., van IJzendoorn, M. H. et al. (2008). Early
parenting intervention aimed at maternal sensitivity and discipline: A process evaluation. Journal of community psychology,
36(6), 780-797.
35
Crill Russell, C., Birnbaum, N., Avison, W.R., and Ioannone, P. (2011). Vital Communities, Vital Support. How well do
Canada’s communities support parents of young children? Phase 2 Report: What parents tell us. Accessed September 26, 2011
at: http://www.phoenixpembroke.com/sites/default/files/Community_Vitality_Phase_2_FINAL_REPORT.pdf
36
Jackson, C. and Dickinson, D. M. (2009). Developing parenting programs to prevention child health risk behaviours: A practice
model. Health education research, 24(6), 1029-1042.
37
McCain, Hon.M.N. and Mustard, J.F. (1999). Early Years Study Final Report: Reversing the real brain drain. Toronto:
Canadian Institute for Advanced Research : The Founders' Network.
38
McCain, Hon. M.N., Mustard, J.F., and Shanker, S. (2007). Early Years Study 2: Putting science into action. Toronto: Council
for Early Child Development.
39
Middlesex-London Health Unit (2004). Measuring positive parenting using the RRFSS: Final report of the perinatal and child
health survey initiative. London, Ontario: Author.
40
Golding, K. (2007). Developing group-based parent training for foster and adoptive parents. Adoption & Fostering, 31(3), 3948.
41
Zepeda, M., Varela, F., and Morales, A. (2004). Promoting positive parenting practices through parenting education. In: Halfon
N, Rice, T., and Inkelas, M. eds. Building State Early Childhood Comprehensive Systems Series, No. 13. National Center for
Infant and Early Childhood Health Policy.
42
Barlow, J., Schrader McMillan, S., Kirkpatrick, S., Ghate, D., Barnes, J. and Smith, M. (2010). Health-led interventions in the
early years to enhance infant and maternal mental health: a review of reviews. Child and Adolescent Mental Health, 15(4), 178185.
43
Clinton, J. (2009). Family Conflict and the Brain. Powerpoint presentation at Improving the Lives of Children and Families in
Conflict, AFCC 2009. http://www.offordcentre.com/ Accessed June 2011.
44
Doyle, A.B., Moretti, M.M., Brendgen, M. and Bukowski, W. (2003). Parent-child relationships and adjustment in adolescence:
Findings from the HBSC Cycle 3 and NLSCY Cycle 2 studies. Ottawa: Health Canada.
45
Burke, K., Brennan, L., and Roney, S. (2010). A randomised controlled trial of the efficacy of the ABCD parenting young
adolescents program: Rationale and methodology. Child and Adolescent Psychiatry and Mental Health, 4.
46
McCart, M. R., Priester, P. E., Davies, W. H., and Azen, R. (2006). Differential effectiveness of behavioral parent-training and
cognitive-behavioral therapy for antisocial youth: A meta-analysis. Journal of abnormal child psychology, 34(4), 527-543.
47
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
93
Kosterman, R., Hawkins, J. D., Haggerty, K. P., Spoth, R., and Redmond, C. (2001). Preparing for the drug free years:
Session-specific effects of a universal parent-training intervention with rural families. Journal of drug education, 31(1), 47-68.
48
Stanton, B. F., Li, X., Galbraith, J., Cornick, G., Feigelman, S., Kaljee, L. et al. (2000). Parental underestimates of adolescent
risk behavior: A randomized, controlled trial of a parental monitoring intervention. Journal of Adolescent Health, 26(1), 18-26.
49
Stormshak, E. A., Dishion, T. J., Light, J., and Yasui, M. (2005). Implementing family-centered interventions within the public
middle school: Linking service delivery to change in student problem behavior. Journal of abnormal child psychology, 33(6), 723733.
50
Lim, M., Stormshak, E. A., and Dishion, T. J. (2005). A one-session intervention for parents of young adolescents: Videotape
modeling and motivational group discussion. Journal of Emotional & Behavioral Disorders, 13(4), 194-199.
51
Baptiste, D. R., Kapungu, C., Miller, S., Crown, L., Henry, D., Martinez, D. et al. (2009). Increasing parent involvement in youth
HIV prevention: A randomized caribbean study. AIDS Education & Prevention, 21(6), 495-511.
52
Lederman, R. P., Chan, W., and Roberts-Gray, C. (2008). Parent—Adolescent relationship education (PARE): Program
delivery to reduce risks for adolescent pregnancy and STDs. Behavioral Medicine, 33(4), 137-143.
53
Toumbourou, J. W., and Gregg, M. E. (2002). Impact of an empowerment-based parent education program on the reduction of
youth suicide risk factors. Journal of Adolescent Health, 31(3), 277-285.
54
Sanders, M. R., and Prinz, R. J. (2008). Ethical and professional issues in the implementation of population-level parenting
interventions. Clinical Psychology: Science & Practice, 15(2), 130-136.
55
56
Triple P – The Triple P System (2011). http://www.27.triplep.net/ Accessed April 29, 2011.
Cowen, P.S. (2001). Effectiveness of a parent education intervention for at-risk families. Journal of the Society of Pediatric
Nurses, 6(2), 73-82.
57
Petra, M. and Kohl, P. (2010). Pathways Triple P and the child welfare system: a promising fit. Children and Youth Services
Review, 32, 611-618.
58
Turner, K. M. T., Richards, M., and Sanders, M. R. (2007). Randomised clinical trial of a group parent education programme
for Australian indigenous families. Journal of Paediatrics & Child Health, 43(6), 429-437.
59
Sanders, M. R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S. et al. (2008). Every family: A population
approach to reducing behavioral and emotional problems in children making the transition to school. The Journal of Primary
Prevention, 29(3), 197-222.
60
Barlow, J., Smailagic, N., Ferriter, M., Bennett, C., and Jones, H. (2010). Group-based parent-training programmes for
improving emotional and behavioural adjustment in children from birth to three years old. Cochrane Database of Systematic
Reviews.
61
Niccols, A. (2009). Immediate and short-term outcomes of the ‘COPEing with toddler behaviour’ parent group. Journal of Child
Psychology & Psychiatry, 50(5), 617-626.
62
Prinz, R.J., Sanders, M.R., Shapiro, C.J., Whitaker, D.J., and Lutzer, J.R. (2009). Population-based prevention of child
maltreatment: The U.S. Triple P System Population Trial. Prevention Science, 10, 1-12.
63
Sanders, M.R., Bor, W., and Morawska, A. (2007). Maintenance of treatment gains: A comparison of enhanced, standard, and
self-directed triple P-positive parenting program. Journal of abnormal child psychology, 35(6), 983-998.
64
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
94
Sanders, M. R., Markie-Dadds, C., Rinaldis, M., Firman, D., and Baig, N. (2007). Using household survey data to inform policy
decisions regarding the delivery of evidence-based parenting interventions. Child: Care, Health & Development, 33(6), 768-783.
65
Halweg, K., Heinrich, N., Bertram, H., and Naumann, S. (2010). Long-term outcome of a randomized controlled universal
prevention trial through a positive parenting program: is it worth the effort? Child and Adolescent Psychiatry and Mental Health,
4, 1-14.
66
Baruch, G., Vrouva, I., and Wells, C. (2011). Outcome findings from a parent training programme for young people with
conduct problems. Child & Adolescent Mental Health, 16(1), 47-54.
67
National Institute for Health and Clinical Excellence (2006). NICE technology appraisal guidance 102. Parent-training
/education programmes in the management of children with conduct disorders. http://www.scie.org.uk/publications/children.asp
Accessed April 2011.
68
Chislett, G., and Kennett, D.J. (2007). The effects of the Nobody’s perfect program on parenting resourcefulness and
competency. Journal of Child & Family Studies, 16(4), 473-482.
69
Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., and MacKinnon, D. P. (2011). Long-term impact of prevention programs to
promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299-329.
70
Dretzke, J., Davenport, C., Frew, E., Barlow, J., Stewart-Brown, S., Bayliss, S., Taylor, R.S., Sandercock, J. and Hyde, C.
(2009). The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of
randomized controlled trials. Child Adolescent Psychiatry Mental Health, 3(7), 1-10.
71
Gardner, F., Burton, J., and Klimes, I. (2006). Randomised controlled trial of a parenting intervention in the voluntary sector for
reducing child conduct problems: Outcomes and mechanisms of change. Journal of Child Psychology & Psychiatry, 47(11),
1123-1132.
72
de Graaf, I., Speetjens, P., Smit, F., de Wolff, M., and Tavecchio, L. (2008). Effectiveness of the triple P positive parenting
program on parenting: A meta-analysis. Family Relations, 57(5), 553-566.
73
Mihalopoulos, C., Sanders, M. R., Turner, K. M. T., Murphy-Brennan, M., and Carter, R. (2007). Does the triple P-positive
parenting program provide value for money? Australian & New Zealand Journal of Psychiatry, 41(3), 239-246.
74
Sanders, M. R., and Prinz, R. J. (2008). Using the mass media as a population level strategy to strengthen parenting skills.
Journal of Clinical Child & Adolescent Psychology, 37(3), 609-621.
75
Tremblay, R., Seguin, J., Zoccolillo, M., Zelazo, P., Boivin, M., Perusse, D., and Japel, C. (2005). The early development of
physical aggression in children. Canadian Research Institute for Social Policy, Policy Brief.
76
Foster, E.M., Prinz, R.J., Sanders, M.R., and Shapiro, C.J. (2008). The costs of a public health infrastructure for delivering
parenting and family support. Children & Youth Services Review, 30(5), 493-501.
77
Gardner, F., Hutchings, J., Bywater, T., and Whitaker, C. (2010). Who benefits and how does it work? moderators and
mediators of outcome in an effectiveness trial of a parenting intervention. Journal of Clinical Child & Adolescent Psychology,
39(4), 568-580.
78
Matthews, R. (2009). Do peer-led parent groups make young mothers better parents? Southern Online Journal of Nursing
Research, 9(4) 8p.
79
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
95
80 Rafferty, Y., and Griffin, K. W. (2010). Parenting behaviours among low-income mothers of preschool age children in the USA:
Implications for parenting programmes. International Journal of Early Years Education, 18(2), 143-157.
Tully,L. (2009). What makes parenting programs effective? An overview of recent research. Research to Practice Notes,
Centre for Parenting and Research, NSW Department of Community Services, June.
81
Barth, R.P. (2009). Preventing child abuse and neglect with parent training: evidence and opportunities. The Future of
Children, 19(2), 95-118.
82
Wiggins, T.L., Sofronoff, K., and Sanders, M.R. (2009). Pathways Triple-P Positive Parenting Program: Effects on parent-child
relationships and child behaviour problems. Family Process, 48(4), 517-530.
83
Lundahl, B.W., Nimer, J., and Parsons, B. (2006). Preventing child abuse: a meta-analysis of parent training programs.
Research on Social Work Practice, 16(3), 251-262.
84
85
Adams, J. F. (2001). Impact of parent training on family functioning. Child & Family Behavior Therapy, 23(1), 29-42.
Cefai, J., Smith, D., and Pushak, R. E. (2010). Parenting wisely: Parent training via CD-ROM with an australian sample. Child
& Family Behavior Therapy, 32(1), 17-33.
86
Kaminski, J. W., Valle, L. A., Filene, J. H., and Boyle, C. L. (2008). A meta-analytic review of components associated with
parent training program effectiveness. Journal of Abnormal Child Psychology, 36(4), 567-589.
87
Scott, S., Sylva, K., Doolan, M., Price, J., Jacobs, B., Crook, C. et al. (2010). Randomised controlled trial of parent groups for
child antisocial behaviour targeting multiple risk factors: The SPOKES project. Journal of Child Psychology & Psychiatry, 51(1),
48-57.
88
Scott, S., O'Connor, T. G., Futh, A., Matias, C., Price, J., and Doolan, M. (2010). Impact of a parenting program in a high-risk,
multi-ethnic community: The PALS trial. Journal of Child Psychology & Psychiatry, 51(12), 1331-1341.
89
The Incredible Years. (2011). The Incredible Years Parent, Teacher and Child Programs Overview of Program Details.
www.incredibleyears.com Accessed April 29, 2011.
90
Pearl, E. (2009). Parent management training for reducing oppositional and aggressive behaviour in preschoolers. Aggression
and Violence Behavior, 14, 295-305.
91
Leung, C., Sanders, M. R., Ip, F., and Lau, J. (2006). Implementation of triple P-positive parenting program in Hong Kong:
Predictors of programme completion and clinical outcomes. Journal of Children's Services, 1(2), 4-17.
92
Lau, A. S., Fung, J. J., and Yung, V. (2010). Group parent training with immigrant Chinese families: Enhancing engagement
and augmenting skills training. Journal of clinical psychology, 66(8), 880-894.
93
Gardner, F., Dishion, T. J., Shaw, D. S., Burton, J., and Supplee, L. (2007). Randomized prevention trial for early conduct
problems: Effects on proactive parenting and links to toddler disruptive behavior. Journal of Family Psychology, 21(3), 398-406.
94
Stallman, H. M., and Sanders, M. R. (2007). "Family transitions triple P": The theoretical basis and development of a program
for parents going through divorce. Journal of Divorce & Remarriage, 47(3), 133-153.
95
Thomas, R., and Zimmer-Gembeck, M. (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.
96
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
96
Mann, B. (2008). What works for whom? Promising practices in parenting education. Ottawa: Canadian Association of Family
Resource Programs.
97
Hartung, D., and Hahlweg, K. (2011). Stress reduction at the work-family interface: Positive parenting and self-efficacy as
mechanisms of change in workplace triple p. Behavior modification, 35(1), 54-77.
98
Rodrigo, M. J. (2010). Promoting positive parenting in Europe: New challenges for the European society for developmental
psychology. European Journal of Developmental Psychology, 7(3), 281-294.
99
100
Healthy Child Manitoba (2011). www.gov.mb.ca/healthychild/about/index.html Accessed May 12, 2011.
Shapiro, C. J., Prinz, R. J., and Sanders, M. R. (2010). Population-based provider engagement in delivery of evidence-based
parenting interventions: Challenges and solutions. The Journal of Primary Prevention, 31(4), 223-234.
101
Simpson, A. R., and Roehlkepartain, J. L. (2003). Asset building in parenting practices and family life. In P. L. Benson (Ed.),
Developmental assets and asset-building communities: Implications for research, policy, and practice. (pp. 157-193). New York,
NY US: Kluwer Academic/Plenum Publishers.
102
McLennan, J. D., and Lavis, J. N. (2006). What is the evidence for parenting interventions offered in a Canadian community?
Canadian Journal of Public Health, 97(6), 454-458.
103
Kumpfer, K.L., Whiteside, H.O., Ahearn Greene, J. and Cofrin Allen, K. (2010). Effectiveness outcomes of four age versions
of the Strengthening Families Program in statewide field sites. Group Dynamics: Theory, Research, and Practice, 14(4), 211229.
104
McIntyre, L. L. (2008). Adapting webster-stratton's incredible years parent training for children with developmental delay:
Findings from a treatment group only study. Journal of Intellectual Disability Research, 52(12), 1176-1192.
105
MacLeod, J. and Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: a
meta-analytic review. Child Abuse & Neglect, 24(9), 1127-1149.
106
Shulruf, B., O'Loughlin, C., and Tolley, H. (2009). Parenting education and support policies and their consequences in
selected OECD countries. Children & Youth Services Review, 31(5), 526-532.
107
Dumas, J. E., Arriaga, X. B., Begle, A. M., and Longoria, Z. N. (2011). Child and parental outcomes of a group parenting
intervention for latino families: A pilot study of the CANNE program. Cultural diversity & ethnic minority psychology, 17(1), 107115.
108
Chislett, G. (2006). Nobody’s Perfect Program – Peterborough: 2003/2004 program outcome evaluation. Peterborough:
Peterborough County-City Health Unit.
109
Morawska, A., and Sanders, M. (2009). An evaluation of a behavioural parenting intervention for parents of gifted children.
Behaviour Research & Therapy, 47(6), 463-470.
110
Kalinauskiene, L., Cekuoliene, D., Van IJzendoorn, M. H., Bakermans-Kranenburg, M., Juffer, F., and Kusakovskaja, I.
(2009). Supporting insensitive mothers: The vilnius randomized control trial of video-feedback intervention to promote maternal
sensitivity and infant attachment security. Child: Care, Health & Development, 35(5), 613-623.
111
Bakermans-Kranenburg, M.J., van IJzendoorn, M.H. and Juffer, F. (2003). Less is more: meta-analyses of sensitivity and
attachment interventions in early childhood. Psychological Bulletin, 129(2), 195-215.
112
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
97
113 Nowak, C., and Heinrichs, N. (2008). A comprehensive meta-analysis of triple P-positive parenting program using hierarchical
linear modeling: Effectiveness and moderating variables. Clinical Child & Family Psychology Review, 11(3), 114-144.
Daley, D., Jones, K., Hutchings, J., and Thompson, M. (2009). Attention deficit hyperactivity disorder in pre-school children:
Current findings, recommended interventions and future directions. Child: Care, Health & Development, 35(6), 754-766.
114
Kacir, C. D., and Gordon, D. A. (1999). Parenting adolescents wisely: The effectiveness of an interactive videodisk parent
training program in Appalachia. Child & Family Behavior Therapy, 21(4), 1-22.
115
Singer, G.H.S., Ethridge, B.L., and Aldana, S.I. (2007). Primary and secondary effects of parenting and stress management
interventions for parents of children with developmental disabilities: a meta-analysis. Mental Retardation and Developmental
Disabilities Research Reviews, 13, 357-369.
116
Whittingham, K., Sofronoff, K., Sheffield, J., and Sanders, M. R. (2009). Stepping stones triple P: An RCT of a parenting
program with parents of a child diagnosed with an autism spectrum disorder. Journal of abnormal child psychology, 37(4), 469480.
117
World Health Organization, Health and Welfare Canada and the Canadian Public Health Association (1987). The Ottawa
Charter for Health Promotion. First International Conference on Health Promotion. Ottawa, 21 November 1986. Accessed
November 24, 2011 at: http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf
118
Rodriguez, M. L., Dumont, K., Mitchell-Herzfeld, S., Walden, N. J., and Greene, R. (2010). Effects of healthy families new
York on the promotion of maternal parenting competencies and the prevention of harsh parenting. Child abuse & neglect, 34(10),
711-723.
119
Matsumoto, Y., Sofronoff, K., and Sanders, M. R. (2010). Investigation of the effectiveness and social validity of the triple P
positive parenting program in Japanese society. Journal of Family Psychology, 24(1), 87-91.
120
Bodenmann, G., Cina, A., Ledermann, T., and Sanders, M. R. (2008). The efficacy of the triple P-positive parenting program
in improving parenting and child behavior: A comparison with two other treatment conditions. Behaviour Research & Therapy,
46(4), 411-427.
121
MacMillan, H. L., Wathen, C. N., Barlow, J., Fergusson, D. M., Leventhal, J. M., and Taussig, H. N. (2009). Interventions to
prevent child maltreatment and associated impairment. Lancet, 373(9659), 250-266.
122
Ralph, A., and Sanders, M. R. (2003). Preliminary evaluation of the group teen triple P program for parents of teenagers
making the transition to high school. Australian e-Journal for the Advancement of Mental Health, 2(3), 10p.
123
Webster-Stratton, C., and Reid, M. J. (2010). Adapting the incredible years, an evidence-based parenting programme, for
families involved in the child welfare system. Journal of Children's Services, 5(1), 25-42.
124
Letarte, M., Normandeau, S. and Allard, J. (2010). Effectiveness of a parent training program “Incredible Years” in a child
protection service. Child Abuse & Neglect, 34, 253-261.
125
Kim, E., Cain, K. C., and Webster-Stratton, C. (2008). The preliminary effect of a parenting program for Korean American
mothers: A randomized controlled experimental study. International Journal of Nursing Studies, 45(9), 1261-1273.
126
Bywater, T., Hutchings, J., Linck, P., Whitaker, C., Daley, D., Yeo, S. T. et al. (2011). Incredible years parent training support
for foster carers in Wales: A multi-centre feasibility study. Child: Care, Health & Development, 37(2), 233-243.
127
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
98
Skrypnek, B.J., and Charchun, J. (2009). An evaluation of the Nobody’s Perfect Parenting Program: Final report. Ottawa:
Canadian Association of Family Resource Programs.
128
McDonald, L., Moberg, D.P., Brown, R., Rodriguez-Espiricuerta, I., Flores, N.I., Burker, M.P. and Coover, G. (2006). Afterschool multifamily groups: A randomized controlled trial involving low-income, urban, Latino children. Children & School, 28(1),
25-34.
129
Steinberg, L., Mounts, N.S., lamborn, S.D., and Dornbusch, S.M. (1991). Authoritative parenting and adolescent adjustment
across varied ecological niches. Journal of Research on Adolescence, 1(1), 19-36.
130
131
Holmes, B., and Silver, M. (2010). Managing behaviour with attachment in mind. Adoption & Fostering, 34(1), 65-76.
Van Zeiji, J., Mesman, J., Van Ijzendoorn, M. H., Bakermans-Kranenburg, M., Juffer, F., Stolk, M. N. et al. (2006).
Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing
behavior problems: A randomized controlled trial. Journal of Consulting & Clinical Psychology, 74(6), 994-1005.
132
Stolk, M., Mesman, J., Zeijl, J., Alink, L., Bakermans-Kranenburg, M., IJzendoorn, M. et al. (2008). Early parenting
intervention: Family risk and first-time parenting related to intervention effectiveness. Journal of Child & Family Studies, 17(1),
55-83.
133
Simpson, A. R., and Roehlkepartain, J. L. (2003). Asset building in parenting practices and family life. In P. L. Benson (Ed.),
Developmental assets and asset-building communities: Implications for research, policy, and practice. (pp. 157-193). New York,
NY US: Kluwer Academic/Plenum Publishers.
134
Roggman, L. A., Boyce, L. K., and Cook, G. A. (2009). Keeping kids on track: Impacts of a parenting-focused early head start
program on attachment security and cognitive development. Early Education and Development, 20(6), 920-941.
135
Rodriguez, M. L., Dumont, K., Mitchell-Herzfeld, S., Walden, N. J., and Greene, R. (2010). Effects of healthy families new
York on the promotion of maternal parenting competencies and the prevention of harsh parenting. Child abuse & neglect, 34(10),
711-723.
136
Gershater-Molko, R., Lutzker, J. R., and Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in
families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18(6), 377-386.
137
Bauer, N. S., and Webster-Stratton, C. (2006). Prevention of behavioral disorders in primary care. Current opinion in
pediatrics, 18(6), 654-660.
138
Breitenstein, S. M., Gross, D., Ordaz, I., Julion, W., Garvey, C., and Ridge, A. (2007). Promoting mental health in early
childhood programs serving families from low-income neighborhoods. Journal of the American Psychiatric Nurses Association,
13(5), 313-320.
139
Pinquart, M., and Teubert, D. (2010). Effects of parenting education with expectant and new parents: A meta-analysis. Journal
of Family Psychology, 24(3), 316-327.
140
Hoffman, J. (2011). Father Factors. What social science research tells us about fathers and how to work with them?
Peterborough: Father Involvement Research Alliance.
141
Clinton, J. M. (2008). The Teen Brain: Under Construction. Powerpoint presentation at the Hamilton Academy of Medicine
Clinical Day, Jan. 30, 2008. www.offordcentre.com/docs/adolescent%20academy.ppt Accessed May 2011.
142
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
99
Slomski Long, M. (2009). Disorganized attachment relationships in infants of adolescent mothers and factors that may
augment positive outcomes. Adolescence, Fall.
143
Coatsworth, J. D., Pantin, H., and Szapocznik, J. (2002). Familias unidas: A family-centered ecodevelopmental intervention to
reduce risk for problem behavior among Hispanic adolescents. Clinical Child & Family Psychology Review, 5(2), 113-132.
144
Unger, D. G., and Nelson, P. (1990). Evaluating community-based parenting support programs: Successes and lessons
learned from empowering parents of adolescents. Journal of Applied Social Sciences, 15(1), 125-152.
145
Swick, K. J. (2009). Strengthening homeless parents with young children through meaningful parent education and support.
Early Childhood Education Journal, 36(4), 327-332.
146
Jouriles, E. N., McDonald, R., Rosenfield, D., Norwood, W. D., Spiller, L., Stephens, N. et al. (2010). Improving parenting in
families referred for child maltreatment: A randomized controlled trial examining effects of project support. Journal of Family
Psychology, 24(3), 328-338.
147
Salveron, M., Lewig, K., and Arney, F. (2009). Parenting groups for parents whose children are in care. Child Abuse Review,
18(4), 267-288.
148
Linares, L. O., Montalto, D., Li, M., and Oza, V. S. (2006). A promising parenting intervention in foster care. Journal of
Consulting & Clinical Psychology, 74(1), 32-41.
149
150 Griffith, A. K., Ingram, S. D., Barth, R. P., Trout, A. L., Hurley, K. D., Thompson, R. W. et al. (2009). The family characteristics
of youth entering a residential care program. Residential Treatment for Children & Youth, 26(2), 135-150.
151
Russell, B. (2011). Supporting Fathers. Presentation to Engaging Fathers Workshop, May 13, 2011.
Magill-Evans, J., Harrison, M.J., Rempel, G. and Slater, L. (2006). Interventions with fathers of young children: systematic
literature review. Journal of Advanced Nursing, 55(2), 248-264.
152
Letourneau, N., Fedick, C.B., Willms, J.D., Stewart, M., and White, K. (2007). Longitudinal study of social-environmental
predictors of behaviour: children of adolescent and older mothers compared. Canadian Studies in Population, 34 (1), 1-27.
153
Owens, J. S., Richerson, L., Murphy, C. E., Jagelewski, A., & Rossi, L. (2008). Erratum: The parent perspective: Informing the
cultural sensitivity of parenting programs in rural communities. Child & Youth Care Forum, 37(1).
154
Robbers, M. L. P. (2008). The caring equation: An intervention program for teenage mothers and their male partners. Children
& Schools, 30(1), 37-47.
155
Morawska, A., and Sanders, M. R. (2009). Parenting gifted and talented children: Conceptual and empirical foundations.
Gifted Child Quarterly, 53(3), 163-173.
156
Seng, A.C., Prinz, R.J., and Sanders, M.R. (2006). The role of training variables in effective dissemination of evidence-based
parenting interventions. International Journal of Mental Health Promotion, 8(4), 20-28.
157
Eames, C., Daley, D., Hutchings, J., Whitaker, C. J., Jones, K., Hughes, J. C. et al. (2009). Treatment fidelity as a predictor of
behaviour change in parents attending group-based parent training. Child: Care, Health & Development, 35(5), 603-612.
158
Herschell, A. D. (2010). Fidelity in the field: Developing infrastructure and fine-tuning measurement. Clinical Psychology:
Science & Practice, 17(3), 253-257.
159
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
100
Nicholson, J., Berthelsen, D., Williams, K., and Abad, V. (2010). National study of an early parenting intervention:
Implementation differences on parent and child outcomes. Prevention Science, 11(4), 360-370.
160
Matsumoto, Y., Sofronoff, K., and Sanders, M. (2009). Socio-ecological predictor model of parental intention to participate in
triple P-positive parenting program. Journal of Child & Family Studies, 18(3), 274-283.
161
Turner, K., and Sanders, M. (2007). Family intervention in indigenous communities: Emergent issues in conducting outcome
research. Australasian Psychiatry, 15 S39-S43.
162
Martinez, J., Charles R., and Eddy, J. M. (2005). Effects of culturally adapted parent management training on Latino youth
behavioral health outcomes. Journal of Consulting & Clinical Psychology, 73(5), 841-851.
163
Nicholson, J.M., Berthelson, D., Abad, V., Williams, K. and Bradley, J. (2008). Impact of music therapy to promote positive
parenting and child development. Journal of Healthy Psychology, 13, 226-238.
164
Region of Waterloo Public Health. (2009, December). ONE Stop: Co-locating programs and services for children 0 - 6 years
of age and their families: A Public Health Perspective. Waterloo, ON: Grace Bermingham.
165
Minister of Health and Long-Term Care (2008). Ontario public health standards. Toronto, ON: Queen’s Printer for Ontario;
2008. Retrieved November, 2010 from: http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/
ophs/progstds/pdfs/ophs_2008.pdf.
166
Region of Waterloo Public Health (2009). RRFSS Monitor. Parenting Consistency. Accessed September 12, 2011 at:
http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/ParentingConsistency_Monitor.pdf
167
KW YMCA Ontario Early Years Centre. (2010). Early Development Instrument data for Waterloo Region for 2009/2010 school
year. Data retrieved from Amy Romagnoli on August 3, 2011.
168
Region of Waterloo Public Health (2012). Reproductive and Maternal Health Status Report. Waterloo, ON: Jessica Deming,
Laura Armstrong, Mike Delorme, Stephen Drew, Lindsay Steckley, Amanda Tavares and Jennifer Toews.
169
Family and Children’s Services of the Waterloo Region. (2010). Active child protection cases between January 1, 2010 and
December 31, 2010. Retrieved from Jill Stoddart on September 21, 2011.
170
BORN Ontario, Niday Perinatal Database (2008-2010). Extracted November 8, 2010 (2008-2009) and May
3, 2011 (2010
171
Region of Waterloo (2009). Immigration. Immigrants in Waterloo Region – Fact Sheet #1. Accessed August 2011 at
http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/Number_Immigrants.pdf
172
Region of Waterloo. (2009). Family Composition & Age. Immigrants in Waterloo Region – Fact Sheet #7. Accessed August
2011 at: http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/FamilyComposition.pdf
173
Region of Waterloo (2009). Immigration Arrivals. Immigrants in Waterloo Region – Fact Sheet #8. Accessed August 2011 at
http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/Immigration_Arrivals.pdf
174
Region of Waterloo. (2011). Health of Immigrants. Immigrants in Waterloo Region – Fact Sheet #10. Accessed August 2011
at: http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/ImmigrantsHealth.pdf
175
176
Tardiff, E. (2009). A Community Fit for Children. A Focus on Young Children in Waterloo Region. Second Edition.
Document Number: 1088831
Document Name: POSITIVE PARENTING EPPF FINAL REPORT
Version: 18
101