Implementation and process issues in using Group Triple P with Chinese parents: Preliminary findings
Lea Crisante
Western Sydney Area Health Service Parenting Program, Cumberland Hospital, Parramatta NSW
Sally Ng
Western Sydney Area Health Service Parenting Program, Cumberland Hospital, Parramatta NSW
PP: 226 - 235
Abstract
The aim of this study was to implement and evaluate a Triple P-Positive Parenting Program Level 4 (Group) intervention with Chinese parents. Forty five Cantonese-speaking parents living in Sydney participated in five groups conducted over a 12-month period.
Implementation aspects included promoting the service to the Chinese community, using an appropriately trained bilingual facilitator, and modifying the process of conducting groups to suit Cantonese-speaking parents. The intervention involved four group sessions followed by four optional brief weekly telephone consultation sessions. Parents were asked to complete the Strengths and Difficulties Questionnaire (Goodman, 2001) before and after the intervention. There were significant improvements on the Prosocial Behaviour Score.
Parents also completed an abbreviated version of the Client Satisfaction Questionnaire (Turner, Markie-Dadds & Sanders, 1998) which showed parents were satisfied with the program, most particularly in relation to receiving the help they required and being helped to deal with their child's behaviour. Given the unwillingness of some parents to complete questionnaires, the difficulties encountered in conducting evaluation in cross-cultural contexts are discussed, along with recommendations for multiple methods in future research.
Keywords
Triple P, groups, Chinese, cross-cultural, evaluation
Article Text
The impact of culture on parenting has long been identified as a major factor in understanding, conceptualising and responding to the needs of children and parents (Fantini & Cardenas, 1980; Kotchick & Forehand, 2002; Kolar & Soriano, 2003). However, the availability of relevant services has remained a significant issue (Sanders, 1997). In Australia, a number of programs have been developed to meet specific parenting concerns, such as the process of parenting 'between' cultures, as well as the needs of refugee families (Kayrooz & Blunt, 2000; Lamelas, 2001).
However, there is also a need for culturally appropriate and sensitive programs which directly address parents' concerns about challenging and difficult behaviours (McDermott, 2001). This arises from the particular parenting stresses that migrant and refugee families face, such as large family size, intergenerational conflicts, and reduced or absent family and social support networks (Bevan, 2000; Kolar & Soriano, 2003; NSW Department of Health, 2003).
A significant issue in service delivery is providing information about services in culturally appropriate ways. Lack of knowledge about services is recognised as one of the key barriers for the participation of culturally and linguistically different communities (NSW Department of Health, 1998; Sue & Sue, 2002).
Through the WSAHS Parenting Program, a parent education service was established several years ago. It is based on the Triple P-Positive Parenting Program, an evidence-based, multilevel, multidisciplinary behavioural family intervention (WSAHS Area Parenting Program, 2002). The program includes a group-based intervention in which parents meet in small groups (Turner et al., 1998). Appropriately trained facilitators introduce various strategies presented in a workbook for parents and an educational videotape. These strategies suggest ways to encourage desirable behaviour in children by using descriptive praise and providing a good example, as well as techniques for managing difficult behaviour through setting ground rules, logical consequences and quiet time. Group-based Triple P interventions have been found to significantly reduce problematic behaviour in children (Williams, Zubrick, Silburn & Sanders, 1997) and have been conducted in a number of countries outside Australia, including Singapore and Hong Kong, using translated materials where required (Leung, Sanders, Leung et al., in press; Triple P News, 2001).
Chinese families have been researched in various ways, including studies of comparative parenting practices (Lin & Fu, 1990), responses to therapeutic interventions (Hsu, 1995) and parenting roles (Garcia Coll, Meyer & Brillon, 1995). Lieh-Mak, Lee & Luk (1984) detail many of the issues encountered by practitioners teaching parenting management skills to Chinese parents in Hong Kong. As a consequence, it is important for parents to deal with inappropriate behaviour, or be seen as not being dutiful parents and bringing shame to their family. Therefore, parents would consider it difficult to ignore inappropriate behaviour in a social situation because it hurts the family reputation (Quan, 2003). The solution offered by Lieh-Mak et al. (1984) is for the practitioner to sympathise with the parent's shame, rather than insist that the strategy of ignoring be used. Other researchers have discussed negative reactions to specific techniques, such as praise, which are commonly used in parent management training (Hsu, 1995).
Few studies have examined the effectiveness of behavioural family interventions in Chinese communities (Leung et al., in press). Ho et al. (1999) suggest that their research conducted in Hong Kong is the first attempt to systematically apply and empirically evaluate a parent management training program in a Chinese population. Their study of parents with children with aggressive and defiant behaviours revealed significant therapeutic gains in several areas, including parents' perception of their parenting behaviours, improved interactions between parents and children and a decrease in externalising behaviours.
The present study extends this limited literature in two ways. Firstly, it is based on a manualised parenting intervention that has been translated into Chinese and conducted by a bilingual practitioner. Secondly, it documents implementation issues involved in conducting parent education programs in a cross-cultural context. The specific aims of this research were (1) to examine the effectiveness of a parent training intervention based on the Triple P Program (Level 4 Group) (Turner et al., 1998) with a group of parents who self-refer in response to a range of promotional strategies, and (2) to document relevant issues which arose in conducting the program.
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