Adopting a population-level approach to parenting and family support interventions☆
Introduction
In both the prevention and treatment arenas, there is an accelerating emphasis on the promulgation of evidence-based interventions for the problems of children and families (Biglan et al., 2003, Kazdin, 1991, Ollendick and King, 2004, Prinz and Connell, 1997). The field of clinical psychology has approached this problem primarily, though not surprisingly, from a clinical perspective focusing on individual children and families. An alternative approach focuses on families from a population and public health perspective. Applying a public health perspective to child and family intervention, a relatively new, innovative, and potentially paradigm-shifting approach is to adopt population-wide strategies that seek to optimize impact and reach larger segments of the child/family population (Sanders et al., 2002, Spoth et al., 2002).
The process issues in a population approach to intervention differ substantially from therapy process issues. Population-based prevention, which is truly a paradigm shift for psychosocial interventions, necessitates the consideration of other processes such as engagement of stakeholders and practitioners, navigating organizational factors, using media and communication strategies to engage the population to achieve sufficient penetration, and facilitating program implementation.
This article considers the rationales and basis for operating at a population level in the area of parenting and family-based interventions. The Section 1 discusses why there is an apparent need for a population-based approach. The Section 2 provides a framework of how to conceptualize such an approach. Finally, the Section 3 provides an example from our own work of a recently initiated prevention trial that illustrates a population-based approach in action.
Section snippets
Prevalence of child behavioral/emotional problems
Child behavioral and emotional problems are quite prevalent in the population, particularly among younger children. Surveys of parents indicate that as much as a quarter to a third of children in the general population exhibit behavioral and emotional problems that present parenting challenges and risk for subsequent adverse outcomes (Burns et al., 1999, Zubrick et al., 1995). Unfortunately, a high proportion of children with behavioral or emotional problems never receive either preventive or
Evidence of efficacy and effectiveness
The presumption underlying the deployment of population level interventions is that the component programs have shown evidence of efficacy and effectiveness. Going to scale at a population level, though potentially cost effective, is nonetheless a major investment that cannot be predicated on programs that have not been sufficiently validated.
The field is just beginning to formulate standards of evidence necessary for broad dissemination of an intervention program. For example, the Society for
Minimally sufficient programming
Population oriented intervention strategies by definition necessitate efficient programming. Treatment and preventive interventions for parents typically have fixed formats such that all families receive the same amount of programming whether needed or not. For example, some therapy programs for childhood conduct problems impose a set length of treatment (typically around 16 sessions), and some home visitation programs aim for a massive number of sessions for every parent (e.g., 50–75 sessions
A research example: the Triple P System Population Trial
An example of population-wide implementation of evidence-based programming for families is found in the Triple P System Population Trial (TPSPT), which illustrates how many of the aforementioned principles can be incorporated into interventions and scientific trials. The TPSPT, currently in progress, aims at a population level to strengthen parenting, reduce risk for child maltreatment, and reduce the incidence of early child behavior problems.
Conclusion
Operating at a population level to positively impact parents and their children requires a shift in our professional thinking. It is no longer sufficient to conduct efficacy trials on parenting and family-based interventions and treatments without considering how such programming can benefit larger segments of the population. The considerations offered here provide the beginnings of a conceptual framework for understanding, studying, and implementing population-based approaches to intervention.
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This research was supported by grant funding (U17/CCU422317) from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.