How do we equip our communities to support children, youth, and families, using the best available science? Over the past several decades, many strategies have emerged from the prevention and behavioral sciences with demonstrated ability to prevent poor and costly outcomes, nurture successful child development, and promote child well-being, safety, and family stability.
The Positive Parenting Program (Triple P) system of interventions, for example, demonstrated substantial impacts reducing child abuse and neglect, out-of-home child placements, and child injuries in an 18-county randomized trial in South Carolina. Furthermore, Triple P has demonstrated in numerous other scientific trials the capability to promote child social, emotional, and behavioral development and increase parents’ confidence to parent with success.
Children, after all, don’t come with a parenting manual, as they say. And as a father of three young children, I’ll be the first to admit that my wife and I have pulled out our parenting tip sheets for advice about how to handle common parenting challenges.
North Carolina’s Division of Public Health and Division of Social Services, along with a handful of local and regional partners, are on to Triple P. They’re hoping that the system of Triple P programs, rolled out so far across 36 counties, can bring similar population-level returns as in the South Carolina trial.
But herein lies the challenge (it’s never as simple as we hope, is it?). Triple P, like all evidence-based prevention and intervention strategies, only reaches its potential programmatic impact when it is fully and effectively implemented in community service systems.
If there is a core tenet in the field of implementation science, it’s that successfully and sustainably scaling a new program in an existing community service system is difficult. It’s messy. Without the right supports and infrastructure, it can even be rare to fully realize the intended benefits.
And this brings me back to my original question: how do we equip our communities to support children, youth, and families, using the best available science? Just having the program or intervention science available, while helpful and necessary to get us going in the right collective direction, apparently isn’t enough. We also need to make use of what we know about effective implementation and scale-up of those programs.
To do this well and sustainably, our state and community systems must shift the ways in which we do business. Evidence and lessons from implementation science suggest that we need to better develop readiness among our community service organizations for implementing new programs. Local leadership and team structures need time and space to innovate, engage with adaptive challenges, and ensure implementation success and sustainability. Our community practitioners must be given the opportunity to benefit from ongoing learning and coaching so that they can deliver innovative programs as intended in ways that respond to family needs. Data monitoring and evaluative processes need to be aligned to identify community needs, conduct quality assurance, and optimize intervention effects over time using data-based quality improvement. And, for population-level impacts, the role of media and social networking strategies must be continually explored as tools to move beyond direct service provision alone.
Just like raising children, these tasks take a village. The advantages of using coalitions of community service agencies and partners to achieve wide scale impacts are becoming clearer. And conversations are accelerating about the need to involve an array of co-creation partners with unique resources, skills, and perspectives, including families themselves, in the local design and scale-up of evidence-based programs. Quite often, state and community systems benefit from external implementation support provided by intermediary organizations and expert technical assistance providers.
Ultimately, supporting science-based strategies for children, youth, and families may be sound policy for federal, state, and local governments, as well as nonprofits and other community service organizations. But they can only own and sustain these strategies, and achieve their promised impacts, by shifting business as usual. They must embed across service sectors the kinds of capacity and practices that are associated with successful and sustainable implementation. The Duke Endowment is helping lead the way by funding the development and initial evaluation of an implementation support plan for Triple P. Testing is slated for Wake, Buncombe and Madison counties.
And I guess this leaves us to ponder another question: what’s my role in helping equip our communities to support children, youth, and families, using the best available science? What role will you play? State and community leaders in North Carolina are having these conversations around Triple P. I invite you to engage with us. After all, it takes a village.
Will Aldridge is the Advanced Implementation Specialist for the FPG Child Development Institute, University of North Carolina at Chapel Hill. He also serves on the Board of Directors, National Prevention Science Coalition. To learn more about how FPG Child Development Institute at the University of North Carolina Chapel Hill is supporting the scale-up of Triple P in North Carolina, visit http://ncic.fpg.unc.edu.