Post on 09-May-2018
2-3-2015
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Helping Families Change Conference 2015, February 25th
Irene Sies (Het ABC)
Marion van Bommel en Jolyn Berns (The Netherlands Youth Institute)
Successful implementation of Triple P
in the Netherlands
© Copyright University of Queensland 2011
Jolyn
Irene Marion van Bommel MSc
Introduction
• Do you know Triple P?
• Relation to Triple P?
• Implementation phase?
Overview
• Triple P in the Netherlands
• Implementation of Triple P in Amsterdam
• What do we know about successful
implementation?
• Visualization results
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Overview
• Triple P in the Netherlands
• Implementation of Triple P in Amsterdam
• What do we know about successful
implementation?
• Visualization results
Triple P in the Netherlands 2004 - 2015
How it all began
• It all started in 2004
• A good (evidence based) program for
parenting support was needed
• Triple P looked promising
• Funding for pilot in three municipalities
Very positive results
• Collaboration within the municipality
improved
• Parents were very enthusiastic about
the program
• Behavioural problems reduced and
parental competence improved
2006 - 2015
• In 2006 Triple P came available in the Netherlands:
- Primary Care
- Group
- Standard
- Seminars
• Triple P rapidly spread
• More Triple P interventions came available
Triple P trained practitioners
Intervention (level) Number of trained practitioners
Brief Primary Care (2) 4675
Seminars (2) 191
Teen seminars (2) 20
Primary Care (3) 4359
Primary Care Teens (3) 905
Discussion Groups (3) 187
Standard (4) 1532
Standard Teens (4) 370
Group (4) 868
Group Teens (4) 326
Standard Stepping Stones (4) 278
Enhanced (5) 349
Family Transitions (5) 126
Total number 14.186 practitioners
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Available in 204 municipalities
Stadsregio Amsterdam: Amsterdam (alle stadsdelen), Zaanstreek Waterland (7 gemeenten), Amstelland (4 gemeenten) en Haarlemmermeer.Noord Brabant: ‘s-Hertogenbosch, Land van Cuyk, Schijndel, Boxtel, Vught, Uden/Veghel,St Michielsgestel, Oosterhout, Eindhoven, Breda, Heusden, Regio Eindhoven (SER, 21 gemeenten ), West Brabant (14 gemeentes), Tilburg, Waalwijk, Dongen, Oisterwijk, Gilze en Rijen, Hilvarenbeek, Loon op Zand, Goirle. Overijssel: Hardenberg, Deventer, Regio Twente: Almelo, Borne, Dinkelland, Enschede, Haaksbergen, Hellendoorn, Hengelo, Hof van Twente, Losser, Oldenzaal, Rijssen-Holten, Tubbergen, Twenterand, Wierden. Noord Holland: Gemeenten in Gooi en Vechtstreek (Bussum,Hilversum, Blaricum, Huizen,Laren,Muiden, Naarden, Weesp Wijdemeren) en Regio Zuid-Kennemerland (Haarlem, Heemstede, Bloemendaal, Zandvoort, Haarlemmerlide & Spaarnwoude)Regio Noord-Kennemerland (Alkmaar, Bergen, Heerhugowaard, Castricum, Heiloo, Langedijk, Graft-De Rijp en Schermer)Regio West-Friesland (Enkhuizen, Drechterland, Medemblik, Opmeer, Koggenland, Stede Broec, Hoorn).Kop van Noord-Holland (Texel, Den Helder, Harenkarspel, Zijpe, Schagen, Hollands Kroon).Regio Midden-Kennmerland: (Velsen, Beverwijk, Heemskerk en Uitgeest).Zuid Holland: Maassluis, Leiden, Leiderdorp, Voorschoten, Kaag Braassem, Zoeterwoude, Oegstgeest, Alphen aan den Rijn, Nieuwkoop, Rijnwoude, Den Haag (alleen JGZ) en Katwijk, Lisse, Hillegom, Teylingen, Noordwijk, Noordwijkerhout.Friesland: Smallingerland, Heerenveen, Achtkarspelen, Leeuwarden, Tytsjerksteradiel, Sudwest Fryslan, Lemsterland, Gaasterlan-Sleat, Littenseradiel, Weststellingwerf, Dongeradiel, Kollummerland, Dantumadiel, Ameland, Terschelling, OpsterlandOverige 11 gemeenten JGZ instellingen.Groningen: Groningen en HoogezandDrenthe: Aa Hunze, Borger Odoorn, Coevorden en Emmen.Gelderland: Renkum, Zaltbommel, Maasdriel, Lingewaal en Regio Noord Veluwe (Putten, Ermelo, Elburg, Oldebroek, Nunspeet, Harderwijk)Limburg: Regio Oostelijk Midden Limburg (4 gemeentes), Regio Oostelijk Zuid Limburg (9 gemeentes), Regio Zuid Limburg (5 gemeentes), regio Westelijk Midden Limburg (3 gemeentes)Zeeland: Goes (allen JGZ) , Terneuzen (CJG)BES Eilanden: Bonaire, Sint Eustatius en Saba
What is implementation?
A specified set of purposeful activities at the
practice, program, and system level designed
to put into place a program or intervention of
known dimensions with fidelity.
Ref: Dean Fixsen and Karen Blasé 2011, NIRN
What we know
70 % of the change processes of Dutch organisations prematurely
freeze or do not reach the intendedeffect (Boonstra, 2000).
Video
What is needed for successful implementation?
Effective program x non effective implementation = 1 x 0 = 0
Non effective program x effective implementation = 0 x 1 = 0
Effective program x effective implementation = 1 x 1 = 1
= Good outcomes for parents and children
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Discussion
What implementation concerns do you
have in your role as practitioner, trainer,
coordinator, manager, researcher?
Overview
• Triple P in the Netherlands
• Implementation of Triple P in Amsterdam
• What do we know about successful
implementation?
• Visualization results
Triple P in Amsterdam
Good starting position:
• Enthusiastic policymakers
• Population approach, including level 1
• Need for implementation recognized
Implementation plan
Key elements:
• Collaboration on different levels
• Phased implementation in 14 districts
• Implementation plan per organization
Collaboration on different levels
Policy makers Managers
Project lead
Intern
coördinators
Phased implementation in 14 districts
• Enthusiastic, advanced districts as a
pioneer
• Good examples and adjusted plans for
reserved districts
• Project lead: connecting experiences
instead of ‘evangelizing’
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Video
Implementation plan per organization
• Which people will be trained?
• How many interventions are expected per
person while doing their regular job?
• From training to practice � need for
support
From training to practice
• Intervision
• Extra time to practice, coaching
• Goal setting, registration, appraisal
• Additional workshops
• Practical framework (e.g. tipsheets,
registration system)
Number of interventions 2009-2014
Looking back…
• Momentum
• Forerunner
• Money can buy anything?!
Overview
• Triple P in the Netherlands
• Implementation of Triple P in Amsterdam
• What do we know about successful
implementation?
• Visualization results
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Importance of implementation
• Focus on training
• Only training is not enough
• Maintenance is hard:
- Meetings with local coordinators
- Training for supervisors
- Workshops for trained practitioners
Important questions
• What is the current situation? Are
changes needed?
• What are your goals?
• Who are you going to train? At what
level?
• How are you going to inform parents
about Triple P?
• What is the budget you need?
• How are you going to maintain you goals?
• ……
Phases of implementation
• Preparation (adoption,
engagement and implementation
planning)
• Implementation (Training and
accreditation)
• Maintenance
‘Kansrijk Implementeren’
Goal of the project:
Research into the implementationproces of
Triple P in the Netherlands
(Trimbos Institute: Ireen de Graaf)
Research ‘Kansrijk Implementeren’
1) Evaluation of the steps in the
implementation process
2) Is Triple P successful implemented in the
Netherlands?
3) Research into the program integrity
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Discussion
• What are your experiences with
the implementation of Triple P in
your country, municipality or
organisation?
• Which steps were/weren’t
followed in your country,
municipality or organisation?
• What are success factors and
what are implementation issues?
Phases of implementation
• Preparation (adoption,
engagement and implementation
planning)
• Implementation (Training and
accreditation)
• Maintenance
1) Evaluation of the steps in the implementation process
Results study 1
• Coordinators didn’t follow all of the steps of the
implementation plan
• Coordinators find ‘Create support among
practitioners’ an important step
• Coordinators have sometimes minimal/little
influence on the implementationprocess
• Coordinators focus more on training than on
the selection of the right practitioners
• Activities from the phase of maintenance were
organised too late
• Coordinators pay little attention to registration
2) Is Triple P successful implemented in the Netherlands?
Succesful implementation:
• The number of started interventions
• The number of interventions that will
be finished completely
• Program integrity
How many practitioners deliver
Triple P after training (%)?
Results study 2
• 54% of the practitioners work with Triple P
after training
• Practitioners performed fewer sessions (than
the standard)
3) Research into the program integrity
Results study 3
• Variation in the way
practitioners deliver Triple P
• Practitioners do not always
carry out the key elements
• Practitioners feel competent
about the way they deliver
Triple P
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Discussion
How can you support practitioners to deliver the program as designed?
Overview
• Triple P in the Netherlands
• Implementation of Triple P in Amsterdam
• What do we know about successful
implementation?
• Visualization results
Collecting more evidence
• Need for evidence based program
• Can we use the structure of the program
(questionnaires) to reinforce the evidence
based character and the implementation
of the program?
• Start of the ‘monitor’ for greater
Amsterdam
Monitoring in (greater) Amsterdam
• Use of the regular questionnaires in an
online environment
• Working with questionnaires is new for
many organizations
• Feels like bureaucracy
Showing results
• Annual factsheet with results for policy,
management and practitioners
• Most active organizations have enough
data for analysis on organization-level �
reinforcement!
• Practitioners discover value for the
individual intervention
Limitations
• Triple P is unique in monitoring
• Large percentage missing data make
results less reliable
• Current transition is looking for ‘efficiency’
and pressurizes the monitoring system.
• Practitioners on turn
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Discussion
• Do you work with questionnaires?
• Is data collected? On what level?
(organisation, municipality, region)
• How are the results used?
Systematically collect information
Dashboards with analysed data
• National level
• Level of municpality
- Organisation
• Level of organisation
- Team
- Practitioner
Number of interventions
Age and sex Satisfaction
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Parenting Scale – pre and post Parenting Scale - effectsize
SDQ Filters
What is implementation?
A specified set of purposeful activities at the
practice, program, and system level designed
to put into place a program or intervention of
known dimensions with fidelity.
Ref: Dean Fixsen and Karen Blasé 2011, NIRN
What is needed for successful implementation?
Effective program x non effective implementation = 1 x 0 = 0
Non effective program x effective implementation = 0 x 1 = 0
Effective program x effective implementation = 1 x 1 = 1
= Good outcomes for parents and children
2-3-2015
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Marion van Bommel: m.vanbommel@nji.nl
Jolyn Berns: j.berns@nji.nl
Irene Sies: ISies@HETABC.NL
Ireen de Graaf: igraaf@trimbos.nl