Using Triple P with Parents from Diverse Cultural Backgrounds

1. 1 Using Triple P with Parents from Diverse Cultural Backgrounds Irene Tymkiw & Sarita Strike (Chartered Educational Psychologists)

2. 2 AIMS The challenge we face providing inclusive parenting programmes in W. London The available research into cultural diversity & parenting How parenting programmes need to accommodate for cultural diversity How Triple P addresses these issues

3. 3 The West London Context

4. 4 London Borough of Ealing Population 300,948 68,241 children and young people 41.3% residents from ethnic minority groups Compared with 9.1% Nationally and 28.8% London wide

5. 5 Complexity of Ethnic Communities in Ealing, W. London Newly arrived immigrants Economic migrants Asylum Seekers/refugees Established communities (up to 4th generation) Arranged marriages

6. 6 Ethnicity and Ethnic Category of Pupils in Ealing Schools (2008)

7. 7 Ealing School Population (Jan 2008) IRENE IS TITLE OK?? IS THIS SCHOOL POP OR EALING GENERAL POP?IRENE IS TITLE OK?? IS THIS SCHOOL POP OR EALING GENERAL POP?

8. 8 Languages in Ealing Schools 100+ languages spoken (2001 census) 45.8% children speak English as first language (Jan 2008) Main languages: Panjabi (9.4%) Somali (8.2%) Urdu (6.1%) Arabic (4.8%) Polish (3.7%)

9. 9 How Ealing is Addressing Issues Practitioner Training Providing trainers from different cultures Representing range of ethnicities and cultures in Ealing Demographic information from training programmes representing borough Ensuring range of languages can be used

10. 10 Progress So Far Trained 41 practitioners 22 White British 5 White other 14 Black and Minority Ethnic

11. 11 Languages 16 different languages spoken Many African e.g. Somali Also Arabic, Panjabi and various European

12. 12 Available Research on Cultural Diversity & Parenting

13. 13 Research Very limited findings in this area of work, especially in the UK Why? �Participation in parenting support by minority ethnic groups and also fathers is generally low and there is a subsequent lack of evidence about what works with them� (Moran et al, 2004)

14. 14 What research tells us about participation: �A number of groups most particularly fathers and MEG, but also parents of disabled children and low income groups were under-represented in the use of mainstream parenting support services�. (PricewaterhouseCoopers 2006 & 2007) Grandparents from minority ethnic groups were keener to participate in parenting programmes than white grandparents. (Barlow, 2004)

15. 15 What Research Tells Us Black and Ethnic Minority parents tending not to complete programmes NFPI audit � only 2% of services nationally specifically targeted ethnic minority groups Majority of research from USA Triple P evaluations of indigenous Australians and some other cultures e.g. Chinese, Japanese No studies of large UK minority groups, e.g. Indian or Pakistani groups

16. 16 Evaluation of the 3 Main Types of Parenting Programme for MEP (Barlow 2004) �Translated� �Adapted� �Culturally specific� Traditional (translated) programmes had more robust evaluations and came out better Culturally specific programmes more variable results. Lack of strong evidence to support and less robust evaluations

17. 17 Commonalities and Differences of Parents� Concerns

18. 18 Listening to Minority Ethnic Parents Their worries, their solutions  National Family & Parenting Institute Survey 2001

19. 19 Listening to Minority Ethnic Parents  National Family & Parenting Institute Survey 2001 BothBoth

20. 20 Universality of Child Development and Best Parenting Practices We know that the basic principles of human learning and child development are universal �It�s likely that children have many common needs that transcend cultural differences and that these needs may be better met by certain parenting practices than others. � (Barlow, 2004)

21. 21 Universality of Effective Parenting Approaches �Understanding disciplining�- NFPI Review of research on what works in managing children�s behaviour. Concluded that children fared best with an authoritative approach to parenting, which combined affection and firm boundaries with an encouragement of children�s independence.

22. 22 Parents� Primary Goals (Levine,1977) Irrespective of race, culture or class all parents have three primary goals: To ensure a child�s physical , social and emotional wellbeing To provide children with the economic competences to survive in adulthood To transmit the values of their culture

23. 23 Additional Tasks Additional tasks as a result of their location within a culture that is different to their own: How to preserve and transmit aspects of their own value system in the face of a dominant culture which may be hostile to such values A challenge to help their children to succeed within a society which may be hostile to such success. (Ref Barlow et al 2004)

24. 24 Further Challenges Faced by MEP

25. 25 How Parenting Programmes need to Accommodate for Cultural Diversity?

26. 26 Family Interventions must be Culturally Appropriate. An effective population strategy should be tailored in such a way that it is accessible, relevant & respectful of the cultural values, beliefs, aspirations, traditions and identified needs of different ethnic groups.

27. 27 Culturally Specific Factors needing Addressing Family structure Roles and responsibilities Predominant cultural beliefs and values Child raising practices Sexuality and gender roles

28. 28 1. Family structure Impact of extended family Sudanese society customs & traditions linked to extended family. Nuclear families rare Family structure is dynamic- Changing patterns in young Asian community Young men�s attitude to fatherhood Young choosing to live in nuclear households Large family size-suggesting communal parenting Pakistani 4.7 children vs. 2.47 white British families. 5-8 children in Sudanese families, often including nephews. � Race Equality Unit (REU) Studies on family life in Africa, Caribbean and Asia emphasise the importance of the wider extended family in family relations. This way of operating within a family has survived the migration process and continues in the UK. It is dynamic, not static e.g. changing patterns in younger generation of Asian.. Young men�s attitude towards fatherhood �from income generating to loving and being responsible particularly in the second generation (lloyd 99) Young south Asian�s are wishing to and are choosing to live within a nuclear family structure, but still maintain extended family obligations Role of grandparents: Barlow et al 2004�s research on parenting programmes and minority ethnic families pointed out that grandparents from MEG�s were more keen to participate in parenting programmes than white grandparents. Reflecting the involvement of the extended family. Intergenerational dynamics. E.g. in Sudanese society, customs and traditions are linked to extended family. Nuclear families are rare. Sudanese children are shared responsibility within the community. Extended family members play a prominent role in child care and disciplining process. Anyone from the broader community has a right to challenge and punish a child�s misbehaviour. Family size (Pakistani 4.7 vs. 2.47 children). Average number of Sudanese children in a family is high (5-8). Evidence large family size may suggest that parenting still remains for the majority a communal activity. (REU)� Race Equality Unit (REU) Studies on family life in Africa, Caribbean and Asia emphasise the importance of the wider extended family in family relations. This way of operating within a family has survived the migration process and continues in the UK. It is dynamic, not static e.g. changing patterns in younger generation of Asian.. Young men�s attitude towards fatherhood �from income generating to loving and being responsible particularly in the second generation (lloyd 99) Young south Asian�s are wishing to and are choosing to live within a nuclear family structure, but still maintain extended family obligations Role of grandparents: Barlow et al 2004�s research on parenting programmes and minority ethnic families pointed out that grandparents from MEG�s were more keen to participate in parenting programmes than white grandparents. Reflecting the involvement of the extended family. Intergenerational dynamics. E.g. in Sudanese society, customs and traditions are linked to extended family. Nuclear families are rare. Sudanese children are shared responsibility within the community. Extended family members play a prominent role in child care and disciplining process. Anyone from the broader community has a right to challenge and punish a child�s misbehaviour. Family size (Pakistani 4.7 vs. 2.47 children). Average number of Sudanese children in a family is high (5-8). Evidence large family size may suggest that parenting still remains for the majority a communal activity. (REU)

29. 29 2. Roles and Responsibilities Children are shared responsibility within the Sudanese community for childrearing Broader community has right to challenge and punish a child�s misbehaviour Intergenerational dynamics- role of grandparent and differing generational attitudes/values.

30. 30 3. Predominant Cultural Beliefs/ Values Different cultures have different values and belief systems (Gross 1996) Europe & USA cultures value Independence and aim to socialize children to be independent competitive achievers African American�s & Asian cultures value interdependence and socialising goals are cooperative, obedient, sharing and respectful children. Affects practices such as bed sharing (Japan)

31. 31 3. Beliefs and Values continued� Mental illness not discussed openly & regarded as weakness in Sudanese culture Chinese cultural belief that �private shame� of family should not be made known to outsiders. (Triple P research) Similarly, maintaining �good name� of family is important in Sudanese culture (refugee council-country facts)

32. 32 4. Child Raising Practices Chinese families are expected to be seen to be dealing with inappropriate behaviour. Ignoring strategy would be difficult to do in social situations because it hurts family reputation. Chinese culture believe praise stops the child from performing better. Therefore may refuse to praise or praise in a mechanistic or unemotional way In Sudan corporal punishment is regarded as part of the child rearing practice

33. 33 Other issues impacting on accessibility: Language issues access to course / written materials Literacy levels � mothers often speak English but don�t read it. In refugees, education may have been interrupted by war. Illiteracy is 74% in Sudanese women in 15-24 age group.

34. 34 How does Triple P address these issues?

35. 35 3 Components for a Successful Parenting Course Successful Recruitment Appropriate content & accessible delivery Retention � low drop out

36. 36 Recruitment A large body of research tells us that Ethnic minority groups, new immigrants and refugee families/asylum seekers parents are less likely to participate in parenting programmes. This is particularly true for fathers and younger parents So there seems to be a problem with recruitment and a need to address this.So there seems to be a problem with recruitment and a need to address this.

37. 37 Listening to ME parents (2001)Differing Attitudes to Parenting Info More open to the need for information & advice about parenting (33% say do not need it vs. 50%) Want more info about teenage years -11-14 age group (25% vs. 14%) B&ME parents find the same sources of information about parenting as useful. Family or friends Local sources- schools, GP surgeries local libraries BothBoth

38. 38 Case Study - Somali Father�s Group Engaging Somali fathers was not easy. The publicity was supported by Project leader making personal contact with individual fathers in the places they would most likely visit: mosque, restaurants, coffee shops, halal butchers. Negotiating suitable time and place for meetings Local community centre venue at the fathers� preferred time (Saturday mornings) Ref: peace of mind project N. London 2004:

39. 39 Case Study- Chinese Culture Culturally sensitive programme promotion helps uptake where seeking help for behaviour can be seen as a weakness or, keeping problems secret from outsiders is the norm Promoting the course as a way of creating happier and less stressed parents was successful.

40. 40 Factors to consider in recruitment: Who we target - mothers, grandparents Location of publicity � local newspapers, CAB, Halal butchers Personal contact - in the community and bilingual facilitators Informal information share Address sensitivity to family honour � alter promotional focus

41. 41 Recruitment factors continued� Promotional materials in ethnic language with relevant images Identify & negotiate practical issues: venue, parking/public transport, time, childcare Support from local leaders � mosque Word of mouth from previous attendees In planning at a population level we need to provide groups open to all which need to be as inclusive as possible.In planning at a population level we need to provide groups open to all which need to be as inclusive as possible.

42. 42 Retention - preventing drop out Programme completion is related to social disadvantage. (Zubrick et al 2005) Children of low income parents who complete course appear to do just as well as more advantaged parents (Sanders et al 2000) Important to encourage completion to maximise exposure. Triple P builds up skills in layers over the 8 week course. First developing positive relationships, then managing misbehaviour.

43. 43 How can practitioners maximise attendance? Ensure course values are in harmony with parent�s values Ensure practical organisation is ideal for parents Selecting parents appropriately at the outset Use information session to check parents understand what course is (& isn�t) and gain commitment. Check language & literacy needs early so appropriate materials / adaptations are available. Be alert to possible drop out. Tailor course flexibly e.g. using other methods of delivery or a combination.

44. 44 Content:Cultural Appropriateness of Triple P Triple P evaluations show: That principles and strategies work in a variety of cultures & cultural contexts. That family income and parent education levels are not related to outcome. Core principles of positive parenting are all fairly universal and each family can interpret them in their own cultural context. Most evaluation in Triple P has been conducted with low income, more disadvantaged sectors of the community. This means that Triple P is effective with MEF which are often disadvantaged Most evaluation in Triple P has been conducted with low income, more disadvantaged sectors of the community. This means that Triple P is effective with MEF which are often disadvantaged

45. 45 5 principles of Triple P Ensuring a safe, engaging environment Creating a positive learning environment Using assertive discipline Having realistic expectations Taking care of yourself as a parent All of these would sit happily in any culture�.All of these would sit happily in any culture�.

46. 46 Achieving cultural sensitivity �Cultural sensitivity� can be demonstrated if programme facilitators help parents identify �their own individual goals� for their children, and by respecting diverse view points and goals� Generic courses �can be individualized to fit with the specific experiences and background of group members, without the need for different curricula for participants from different backgrounds.� (Reid , Webster-Stratton et al 2001).

47. 47 How Triple P achieves cultural sensitivity through �self regulation� Core unifying principle is Self Regulation: Each parent is responsible for the way they choose to raise their children. They select aspects of their own and their children�s behaviour to work on. They set goals & choose specific culturally acceptable parenting strategies. The aim of the programme is for parents to become confident, resourceful, independent problem solvers. Avoids directly challenging cultural belief Focuses on changing specific parent�child interactions identified by the parents as unhelpful- parenting traps This is a core feature to enable the programme to be culturally sensitive as it ensures that the parent leads the focus of the course for them. They decide their own and their children goals in week one and these will be defined by their culture and by there cultural beliefs around what makes a good parent. goal of professional training is to increase practitioners self efficacy in consulting with parents using self regulation framework. Avoids directly challenging cultural belief Focuses on changing specific parent�child interactions identified by the parents as unhelpful- parenting traps This is a core feature to enable the programme to be culturally sensitive as it ensures that the parent leads the focus of the course for them. They decide their own and their children goals in week one and these will be defined by their culture and by there cultural beliefs around what makes a good parent. goal of professional training is to increase practitioners self efficacy in consulting with parents using self regulation framework.

48. 48 Tailoring: 5 different levels of intensity.

49. 49 Tailoring to individual family needs Flexible delivery format Individualised component Customise to the participating mix of clients Sensitive to the beliefs, assumptions, expectations traditions and values of families Triple P is the only evidenced based parent training programme that has the same core principles and strategies at 5 different levels of intensity. This allows more tailoring to parents needs. It has Flexible delivery format�. (Group, individual, telephone & self directed also Media (TV) delivered and Web-based delivery -in development). Therefore it can be adapted to parents according to need. In triple P an individualised component is incorporated telephone calls for 3 weeks tailor the programme to a families individual needs. In stepping stones, programme for children with additional needs these are home visits. This is an unusual feature. Training for professionals strongly emphasises the need to customise to the participating mix of clients in a group (for e.g. Pt of downs syndrome child in standard group- use of some Stepping Stones materials to complement programme) this is helped by the 3 weeks individualisation by telephone. In training all practitioners are encouraged to be sensitive to the beliefs, assumptions, expectations traditions and values of families. Triple P is the only evidenced based parent training programme that has the same core principles and strategies at 5 different levels of intensity. This allows more tailoring to parents needs. It has Flexible delivery format�. (Group, individual, telephone & self directed also Media (TV) delivered and Web-based delivery -in development). Therefore it can be adapted to parents according to need. In triple P an individualised component is incorporated telephone calls for 3 weeks tailor the programme to a families individual needs. In stepping stones, programme for children with additional needs these are home visits. This is an unusual feature. Training for professionals strongly emphasises the need to customise to the participating mix of clients in a group (for e.g. Pt of downs syndrome child in standard group- use of some Stepping Stones materials to complement programme) this is helped by the 3 weeks individualisation by telephone. In training all practitioners are encouraged to be sensitive to the beliefs, assumptions, expectations traditions and values of families.

50. 50 Process issues Triple P provides and advocates a �tool box� of strategies This allows parents to pick and choose what works for them & what they feel comfortable with.

51. 51 Overcoming Language Barrier: Triple P Translations Culturally sensitive translation of core materials Customise materials as needed (types of examples used, video models, images used to represent culture) Key UK languages not yet available Albanian Portuguese Dutch German Turkish Farsi Vietnamese Mandarin Japanese Urdu (in progress) French (in progress) Malay (in progress) Spanish (in progress)

52. 52 Overcoming Language Barrier Triple P reading age 11 yrs. Reading materials and writing tasks optional Taping workbook in English Demonstration & DVD for teaching strategies further vignettes needed, with cultural examples. Translated questionnaires: SDQ downloadable in 40 languages Translate questionnaires � check with community Bilingual practitioners in key languages. Aim of Ealing�s parenting strategy. Interpreters - issues of cost & ensure awareness course principles. Extra time issues Interpreters (e.g. Tamil course). Issues: cost and ensuring understanding of course principles. Extra time issues Interpreters (e.g. Tamil course). Issues: cost and ensuring understanding of course principles.

53. 53 Conclusion The challenges of providing cultural sensitive parenting Cultural Diversity in UK is complex & dynamic Research shows more similarities than differences in Child development Effective parenting approach Outcomes for families on parenting programmes Parents� concerns and fears Differences in cultural beliefs & values may affect recruitment & retention Triple P successfully addresses Cultural sensitivity by Self Regulation and tailoring Language barrier is the greatest challenge in delivery Studies across cultures show that there are more similarities than differences in both child and parent outcomes. There are many commonalities in child development, parenting requirements and parents concerns across our diverse society. The UK experience with meeting the needs of Minority Ethnic parents and parenting is complex, it has occurred over a long time and is dynamic. Triple P can be used successfully and meets many of the requirements in a diverse community. As practitioners our experience is that language barriers produces the greatest problem for recruiting, retaining and delivery of parenting successfully. Further translations are needed for the British language diversity. Availability and cost of interpreters, monitoring of ethnicity and home language is necessary to ensure delivery is effective. Continued research and evaluation is important. At the end of the day all families are individual and the flexibility of Triple P allows true individualisation of the experience each parent has. Studies across cultures show that there are more similarities than differences in both child and parent outcomes. There are many commonalities in child development, parenting requirements and parents concerns across our diverse society. The UK experience with meeting the needs of Minority Ethnic parents and parenting is complex, it has occurred over a long time and is dynamic. Triple P can be used successfully and meets many of the requirements in a diverse community. As practitioners our experience is that language barriers produces the greatest problem for recruiting, retaining and delivery of parenting successfully. Further translations are needed for the British language diversity. Availability and cost of interpreters, monitoring of ethnicity and home language is necessary to ensure delivery is effective. Continued research and evaluation is important. At the end of the day all families are individual and the flexibility of Triple P allows true individualisation of the experience each parent has.

54. 54 Contact Details Sarita Montes Strike sarita@strikeconsulting.co.uk Irene Tymkiw itymkiw@ealing.gov.uk