Abstract: A Quasi-Experimental Effectiveness Study of the Triple P Parenting Program on Child Maltreatment Prevention (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Sunday, January 14, 2018: 10:07 AM

Marquis BR Salon 10 (ML 2) (Marriott Marquis Washington DC)

* noted as presenting author

Paul Lanier, PhD, Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Samantha Schilling, MD, Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Meghan Shanahan, PhD, Research Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Adam Zolotor, MD, Associate Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Background and Purpose: In 2012 and 2013, 34 of 100 counties in North Carolina implemented the Positive Parenting Program (Triple P). Triple P is a parenting and family support intervention designed to enhance parental skills and competence to better respond to child behavioral and emotional challenges. Randomized controlled trials (RCTs) of Triple P have provided strong evidence that the program is effective in reducing risk for child maltreatment at the parental level, as well as reducing rates of child maltreatment at the population level. However, investigator-led RCTs of Triple P have received recent scrutiny due to potential conflicts of interest. As Triple P is scaled up, research methods are needed that assess effectiveness using rigorous methods that allow causal inference, but minimize potential investigator bias. Difference-in-differences is a quasi-experimental design that is typically used to compare observational data on a given outcome before and after a policy change. Given the fairly rapid scale-up of Triple P in some geographic areas (and not others), difference-in-differences analysis can be used to estimate program effectiveness in the context of a natural experiment.

Methods: During 2012 and 2013, the state of North Carolina funded 31 counties to implement Triple P. The remaining 69 counties did not implement Triple P. A panel data set with county-level child welfare data and emergency department discharge data from 2008 to 2015 for 100 counties in North Carolina was constructed. A difference-in-difference analysis was performed using negative binomial regression to evaluate the impact of Triple P on the rate of investigated child maltreatment reports. The analysis was repeated with county rate of children in foster care and emergency department (ED) visits using a validated algorithm of ICD-9 codes.

Results: Implementation of Triple P resulted in a 5% decrease in the county rate of investigated reports of child maltreatment (RR = 0.95, 95% CI [0.92, 0.98]) and a 7% decrease in the county rate of children in foster care (RR = 0.93, 95% CI [0.88, 0.98]). There was no reduction in county level rates of ED visits with specific or suggestive ICD-9 codes for child physical abuse or neglect.

Implications: Implementation of Triple P outside of the parameters of an RCT was associated with small but significant reductions in the rates of investigated reports of child maltreatment and children placed in foster care. However, results indicate no significant reduction in ED visits for maltreatment injuries. Our findings indicate that a “real-world” scale-up of Triple P may have smaller effect sizes than reported in prior RCTs, further supporting the need to examine the facilitators and barriers of successful implementation of evidence-based interventions.