Adopting a population-level approach to parenting and family support interventions

Abstract

Evidence-based treatments and preventive interventions in the child and family area have not met with widespread adoption by practitioners. Despite the high prevalence of child behavioral and emotional problems, many parents and families in need are not receiving or participating in services, and when they do, the most efficacious interventions are not what is usually provided. Simultaneously addressing the issues of low penetration and insufficient dissemination of evidence-based programming requires a population approach to parenting and family support and intervention. Process issues are important, particularly in relation to engagement of stakeholders, recruitment of practitioners, consideration of organizational factors, and use of media and communication strategies. This article discusses why there is a need for a population-based approach, provides a framework of how to conceptualize such an approach, and describes an example from our own work of a recently initiated prevention trial that illustrates a population-based approach in action. The rationale, structure, and goals of the Triple P System Population Trial are described in the context of the aforementioned population framework.

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.