**Every Family: The Australian Triple P System Population Trial** ----------------------------------------------------------------- Parenting and Intergenerational Disadvantage: A population trial of the Triple P system of parenting and family support ------------------------------------------------------------------------ **Overview** ---------- **Objectives** This project aims to determine the effectiveness of targeting a single capability such as parenting skills in a cost-effective way to prevent or reduce multiple risks associated with disadvantage and represents the first international population trial of a social intervention of this kind. The project will evaluate whether an integrated system for providing families with access to evidence-based parenting skills (the Triple P Positive Parenting Program System; TPS) has the potential to reduce risk factors associated with the intergenerational transmission of deep and persistent disadvantage (DPD) at a population level. The project will use quasi-experimental observational research design involving 32 socially disadvantaged communities within Queensland matched to similar communities within another Australian state who have not been exposed to the Triple P System. **Design** Quasi-experimental observational **Outcomes** Primary Child Outcomes: Child maltreatment, educational attendance and achievement Secondary Outcomes: Child - Child developmental vulnerability as assessed by the Australian Early Development Census (physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), communications kills and general knowledge) Parent and Family- family cohesion, parental mental health symptoms (depression, stress) **Interventions** The multi-level Triple P System: “Stay Positive” communications campaign; Positive Parenting Seminars and Discussion Groups; Triple P Online; Group Triple P, Standard Triple P, Enhanced and Pathways Triple P **Number of Subjects** N=32 Queensland Intervention communities; N=32 Comparison Communities in another Australian state **Population** Families of 3-8 year olds living in communities within the bottom 35% of SEIFA within one of three Queensland Local Government Areas (SA2) excluding areas with greater than 30% Indigenous residents or fewer than 300 children. **Background & Rationale** ------------- Social disadvantage is worsening, with Australia having the third highest rates of income inequality in the rich world, behind only the United States and the United Kingdom according to the OECD, despite scoring second highest on aggregate measures of income, health and educational attainment, behind Norway. The Australian Productivity Commission identifies deep and persistent disadvantage as a significant problem in Australia, given the failure of growing national prosperity to benefit underprivileged Australians over the past two decades. New solutions are needed to underpin the Australian social ideal of a “fair go”, and to drive future economic productivity. There are several social circumstances that are common indicators of disadvantage and vulnerability, including poverty, homelessness, unemployment, incarceration, and social isolation. The intergenerational transmission of these adversities has been well documented. Similarly, the negative cumulative effects that adverse childhood experiences (ACEs) have on children and adults psychosocial wellbeing, mental and physical health and parenting styles {e.g.`, \Chung, 2009 #1726;Schilling, 2007 #165} have also been demonstrated. For example, Felitti, Anda, Nordenberg and colleagues {, 1998 #110} explored the relationship between health risk behaviours and disease with exposure to abuse (psychological abuse, sexual abuse, physical abuse) and household dysfunction (substance abuse, mental illness, mother treated violently and criminal behaviour in household) during childhood in a sample of 9,508 adults. Findings showed that as the extent of exposure to ACEs increased so too did the risk and prevalence of health risk behaviours and disease risk factors. Individuals who had experienced four or more categories of exposure during childhood had a 4 to 12-fold increase in risk for developing problems with alcohol and other substances, depression and suicide attempts, poor levels of self-rated health and a range of physical illnesses (e.g., ischemic heart disease, cancer, chronic bronchitis or emphysema, diabetes, history of hepatitis or jaundice, skeletal fractures) and greater health care utilization and mortality rates. Critically, the effects of ACE’s have also been shown to traverse generations with experiences within the family having considerable influence on outcomes for children well into their adulthood. **The Role of the Family Environment and Parenting** Family background and the family environment play a central role in determining the adult outcomes of young people. For example, the experience of social disadvantage (low SES, living standards), family conflict, violence and breakdown, parental mental illness and substance misuse and exposure to childhood physical and sexual abuse by parents are all factors that are associated with social, emotional, academic and behavioural problems in children, and are family factors that are known to persist across generations {Farrington, 2009 #1689}. Parenting has long been shown to be critical to the development and wellbeing of children. Effective parenting, characterized by a warm, loving relationship combined with clear expectations and rules, discipline practices, and effective supervision have been linked to positive health and developmental outcomes for children. Equally, harsh and coercive parenting practices have been linked to a range of poor outcomes for children as they mature through adolescence and into adulthood, including higher incidences of mental health and/or substance addictions, school failure and unemployment and relationship problems. Parenting practices are highly likely to transfer from one generation of parents to the next {Capaldi, 2008 #1679;Chung, 2009 #1726} thus adding to the intergenerational transmission of disadvantage for children living in impoverished environments. For example, in Capaldi, Pears, Kerr and Owen’s {, 2008 #1679} study of harsh discipline practices in at-risk men, childhood experience of harsh discipline was related to their own use of harsh discipline with their 2- to 3-year-old children. Similarly, Chung and colleagues {, 2009 #1726} in their study of infant smacking found that parents who had been exposed to physical or verbal abuse during childhood were more likely to smack than mothers without this history of abuse. **Parenting as a Modifiable Risk Factor** While factors associated with economic and social disadvantage clearly impact on parents’ resources (both internal and external) and are risk factors for poor child outcomes, they do not in themselves prevent parents from being effective in their parenting role. A raft of research has demonstrated that parenting is a modifiable risk factor that can be directly targeted via evidence-based parenting interventions {Serketich, 1996 #652;Dretzke, 2009 #1090}. The evidence for parenting interventions in assisting parents to promoting effective parenting practices and a high-quality nurturing parent-child relationship at the individual family level is substantial. Participation in parenting programs based on social learning theory {Bandura, 2000 #1233} and cognitive and behaviour change principles (Biglan, 2015) such as Parent-Child Interaction Therapy {Thomas, 2007 #756}, the Incredible Years {Jones, 2007 #98} and the Triple P – Positive Parenting Program {Sanders, 2014 #1570} have been shown (across studies, different countries and in both home and community settings) to be associated with sustained reductions in externalizing and internalizing child behaviour problems, improvements in parental wellbeing (parental confidence and effectiveness, anxiety, depression and self-esteem) and improved parenting practices that enhance the quality of parent-child relationships. Recent studies have also demonstrated effects within socially disadvantaged communities {Prinz, 2009 #1610;Mejia, 2015 #1745} **Triple P – Positive Parenting Program** The Triple P multi-level system of parenting and family support has been subjected to considerable empirical scrutiny both in Australia and internationally with more than 200 separate evaluations (see Sanders et al, 2014 for the most comprehensive meta-analysis of the available evidence) conducted to-date. Approximately 200 published evaluations have shown favourable outcomes for Triple P. Several population studies {Fives, 2014 #1746;Prinz, 2009 #1610} have shown that the Triple P system when delivered as a population level intervention: - Reduces child maltreatment - Reduces social and emotional problems Recent findings from the 15 year follow-up the universally offered Group Triple P program in Perth, Western Australia highlighted the potential of programs like Triple P to make a lasting difference on factors that are associated with health and development of children. Smith {, 2014 #1747} noted that Triple P appears to provide a minimal-investment solution for parents to provide a meaningful long-term benefit to their child’s developmental trajectory, especially within the education domain where the pattern of results strongly suggested that Triple P resulted in a lasting, long-term positive effect on literacy and numeracy achievement. Triple P has its origins in social learning theory and the principles of behaviour, cognitive, and affective change articulated in the 1960s and 1970s {Sanders, 2012 #1459}. Triple P is based on a public health model of parenting and family support and aims to preventing severe behavioural, emotional, and developmental problems in children and adolescents by enhancing the knowledge, skills, and confidence of parents. To achieve this goal, Triple P incorporates five levels of intervention on a tiered continuum of increasing strength and narrowing population reach for parents of children from birth to age 16. Triple P strategies are based on five core principles of positive parenting: providing children with a safe engaging environment; providing a stimulating learning environment; having realistic expectations; using assertive discipline (responding immediately, decisively and consistently to inappropriate behaviour); and parental self-care {Sanders, 2012 #1459}. To assist parents to learn and implement these strategies the Triple P system adopts active skills training processes that support individuals to initiate, achieve and maintain behaviour, cognitive and affective changes in their own and their children’s lives {Sanders, 2013 #1537}. **Triple P as a Mechanism of Population Level Change** As already noted, the evidence for Triple P is extensive. To our knowledge the Triple P – Positive Parenting program is the only fully integrated social intervention that is multi-modal, multi-disciplinary and multi-level enabling families to access a blend of universal and targeted evidence based support irrespective of individual circumstance or severity of need. Further, the Triple P system targets a set of risk and protective factors, associated with disadvantage that are directly modifiable. As such, a trial investigating the effects of the Triple P system at a population-based level offers a unique opportunity to explore the impact of integrated approaches to social challenges on critical risk and protective factors associated with intergenerational transmission of community disadvantage. There are a number of gaps in our understanding of the effects of parenting on children, families and our society and in our ability to influence the uptake of effective evidence-based interventions. Specifically, no study has examined the effects of a comprehensive integrated, evidence-based system parenting support system such as Triple P specifically in the most socially disadvantaged areas where families experience high levels of persistent intergenerational disadvantage. Further, while we know much about the effects of Triple P on individual children and families, we do not yet fully understand the impact that the investment in parenting support has on the broader community. For example, how the Triple P system may impact community level indicators such as family violence, school attendance and achievement, child literacy rates, nor do we know the impact that this has on parental connectedness, social isolation, parental employment and welfare dependency. In addition, we do not yet know how implementation of the system influences other parents who reside in the community but who do not directly participate in Triple P via a social contagion effect (peer to peer advocacy) among parents. To date most studies have captured the effects of parenting interventions on individual risk factors but have not concurrently measured a range of indices of risk and protection. The population studies that have been undertaken to date have demonstrated effects on outcomes such as child behaviour problems {Fives, 2014 #1746} and child maltreatment {Prinz, 2009 #1610}. However, both studies reported relatively modest numbers of direct participants in a Triple P intervention (approximately 15% and between 9 – 14% of the population, respectively). The mechanisms for the changes across the populations involved in these trials is unclear. The population trial in Ireland {Fives, 2014 #1746} did point to the emergence of a ‘social contagion’ process by which participants in the parenting interventions shared their experiences and learnings with other, non-participating members of their community. A central goal of the Triple P system is the development of an individual’s capacity for self-regulation {Sanders, 2008 #1525}. Self-regulation is a process whereby individuals acquire the skills they need to change their own behaviour and become independent problem solvers and controllers of their own destiny. Capacity for self-regulation occurs in a broader social environment that supports parenting and family relationships {Karoly, 1993 #1349}. Drawing heavily on Bandura’s cognitive social learning theory {e.g.`, \Bandura, 1991 #1232} this Triple P model describes both the processes by which individuals can change their behaviour and the social interactional contexts that promote the capacity to change. In the case of parents learning to change their parenting practices, self-regulation is operationalised as a multi-component process involving five key elements: 1) Self-management tools - tools and skills to change their parenting practices (e.g., self-determination of parenting goals, self-monitoring of specific parent and child behaviours, self-selection of change strategies, self-evaluation of achievement of performance criterion and self-reward for goal attainment); 2) Parental self-efficacy - increasing parents’ confidence in their capacity to solve personally relevant problems; 3) Personal agency - encouraging parents to attribute changes or improvements in their family situation to their own or their child’s efforts rather than to chance, age, maturational factors, the practitioner’s skills or other uncontrollable events (e.g., a spouse’s poor parenting or genes); 4) Self-sufficiency - encouraging the parent to become an independent problem solver who has the personal resources, knowledge and skills to maintain any gains achieved and to tackle future problems with the same child or other children in the family; and 5) Problem solving - Parents are equipped to define problems more clearly, formulate options, develop a parenting plan, execute the plan, and evaluate the outcomes achieved and to revise the plan as required for current and future problems. Evaluations of Triple P have demonstrated that participation results in improvements in an individual’s capacity to self-regulate. We hypothesise that by improving the self-regulation of a considerable proportion of parents living in socially disadvantaged communities, and in particular by building parents beliefs that they can produce valued changes in their own and their children’s lives, we will see significant reductions in a range of risk indices that compromise children’s development. It is possible that by achieving an increase in the levels of self-efficacy and personal agency relating to parenting in enough individuals across a community we may activate wider community processes that have been shown to benefit outcomes for children. The Triple P system has the potential to not just improve parenting but to also create a critical mass (threshold) and activate social ties, thus providing a potential mechanism by which parents may begin to view others in their community as having shared values and skills for improving their community’s ability to protect and promote the wellbeing of their children. The multi-level system of Triple P, commences with a population-level campaign designed to disseminate and normalise key principles for protecting and supporting children’s health, safety, development and learning. Such an approach combined with targeted group based and individual support for families across the community has the potential to result in improved self-efficacy and confidence to parent children across the community along with the development of a set of shared beliefs regarding the needs of children within the community. This in turn may influence the quality and number of ties parents feel to their community. In this way the Triple P System may operate as an agent to facilitate activation of the community to achieve goals of benefit to their children. {Sampson, 2004 #1991} also notes the role of organisations in promoting collective efficacy and support the capacity of communities to sustain social action. The implementation framework for the Triple P System involves engaging multiple agencies and government stakeholders to support and disseminate the key messages of positive parenting. **Queensland Triple P System Statewide Implementation** In 2015, the Queensland Government Department of Communities, Child Safety and Disabilities funded a statewide roll-out of the Triple P System, the Queensland Government Triple P Implementation (QGTPi). The goal of this government initiative is to provide access to the Triple P program for all Queensland families with a target of 140,000 participants between 2015 and 2017. Future targets will be announced following this initial implementation period. The QGTPi covers all five levels of the Triple P System and variants suitable for families with children aged 2 – 16 years. The QGTPi is managed by Triple P International (TPI) who are responsible for all deliverables as part of this initiative. **Study Aims** -------------- In parallel with the Queensland implementation a quasi-experimental observational study will be conducted to explore the population level effects of the TPS in high risk, low SES communities across a range of factors shown to be associated with social disadvantage. This project will extend knowledge of the role of evidence-based parenting support in promoting social transformation at a community level and addressing intergenerational transmission of deep and persistent disadvantage. The study will investigate the effects of the systematic implementation of a whole of population-based approach to the provision of parenting support to families of young children (aged 3-8 years) for high risk, low socio-economic communities. The project will aim to examine the impact of the TPS on community level indices of child, family and community wellbeing in economically deprived communities **Hypotheses** -------------- **1. Primary child outcomes** H1a. Lower rates of child maltreatment as reflected by lower rates of notifications; and substantiations for child maltreatment of a) children in need of protection and b) children not in need of protection; lower rates of emergency hospital admissions for child maltreatment related injuries; and lower rates of out of home placements; H1b. Greater success at school as reflected by higher rates of school attendance, higher rates of school achievement on NAPLAN testing. **2. Secondary child outcomes** Our secondary outcome relates to the well-being of children. Compared to children residing in communities in which the Triple P System is not present (Comparison) communities we hypothesize that children living in communities that have implemented the full Triple P System (Every Family) will experience: H2a. Less developmental vulnerability as reflected by improvements on the physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), communication skills and general knowledge domains of the Australian Early Development Census **3. Secondary parent and family outcomes** Our secondary parent outcomes relate to hypothesized mechanisms of change in parenting and family factors. Compared to CAU communities, parents in Triple P Systems Communities (Every Family) will experience: H3a. lower proportions of parents who have mental health symptoms **4. Secondary community outcomes** Our secondary level outcomes relate to the intervention effects on community level factors indirectly targeted by the intervention as reflected by: H4a. a higher percentage of families who perceive their neighbourhood to be safe; increase in the number of children who are seeking assistance through treatment and support services. NOTE: The exact variables of interest will be identified as part of this project in collaboration with State and Federal Government Departments (see Section 4: Evaluation). **Method** ---------- **Proposed Sampling Design** As the current study will be run in parallel with a Government funded statewide implementation of the TPS it is not feasible to adopt a controlled experimental design. However, the primary goal of the study is the same as would be investigated within an experimental design: to estimate the effect of the Triple P System on population level indicators of child, family and community wellbeing associated with social disadvantage. To achieve this, the quasi-experimental observational study will use an evaluation approach such as matching techniques to account for differences between the included TPS and a set of comparison communities. **Identifying Matched Intervention and Control Communities** Matching techniques will be used to establish a set of Intervention and Control communities that are matched on a number of observed characteristics (e.g., SES, number of children in the target age range, Rural versus Urban geography; proportion of Indigenous residents). In this way matching attempts to mimic randomization by generating a sample of units that receive an intervention that is comparable on all observed, baseline covariates to a sample of units that did not receive the intervention. This reduces bias due to confounding variables and supports causal inference in non-experimental studies by producing an unbiased estimate of the treatment effect. Federal and State Government Administrative Data will be linked and/or merged to create a data set for comparing Intervention and Control Communities across a range of indicators of child and family outcomes (e.g., child maltreatment, non-accidental injury and visits to paediatric emergency departments, out of home placements, school attendance rates, family composition and breakdown and family violence). Specific factors to be measured will be determined by the research team in collaboration with the Federal Department of Social Services and the Queensland Department of Communities. The data linkage/access process with be managed by the research team in collaboration with aforementioned Government Departments and the Australian Institute of Health and Welfare (AIHW) who are a Commonwealth Integrating Authority (an organisation with Federal approval to conduct data integration research involving State and Commonwealth data). The extensive use of administrative data in this project will enable the examination of the effect of the Triple P system on communities across a range of never before tested variables, thus creating a greater understanding of the contribution of parenting and parenting support programs delivered within a public health model to the wellbeing and functioning of communities and the families living within them. For the purposes of the current study, the ABS geographically defined SA2 statistical area level will be used to represent a community. These regions have populations in the range of 3000 and 25000 persons. The study will target communities which consist of the following characteristics: - Identified SA2s are located within one of three Local Government Areas within Queensland: Ipswich, Moreton Bay and Toowoomba - The SA2 has a percentile ranking on the ABS SEIFA index of disadvantage within the bottom 35 %; - A minimum of 300 families with children aged 3-8 years residing in the community; - Less than 30% of residents are of Indigenous or Torres Strait Islander descent **Comparison Communities** The eligibility criteria for Intervention communities has been applied to SA2s from another Australian state to identify a pool of qualifying SA2s that can be used to match Intervention and Control communities across a set of covariate and outcome variables (see Section: Matching Techniques). In addition, to be eligible for use in matching analysis, comparison communities will not have had any systematic implementation of the Triple P System. It is possible that Triple P programs will be available within the comparison communities and/or that other Government initiatives will occur during the implementation period. We will track and record the policy and service context for all matched communities. Statewide matches for all viable Queensland intervention communities (SA2s) were identified using ABS 2011 census data, AEDC data and ARIA data. Matching parameters were as follows: - Child population of 3 to 8 year olds is +/- 5% children of qualifying SA2 child population - Australian IRSAD is +/- 5% of qualifying SA2 Australian IRSAD - Indigenous population is +/- 5% of qualifying SA2 Indigenous population - ARIA Score, Area and Class match qualifying SA2 ARIA classification - Total SA2 population is +/- 5% of qualifying SA2 range - Percentage of low income families is +/- 5% of qualifying SA2 range - Percentage of high income families is +/- 5% of qualifying SA2 range - Percentage of jobless parents is +/- 5% of qualifying SA2 range - Percentage of unemployment is +/- 5% of qualifying SA2 range - Percentage of single parents is +/- 5% of qualifying SA2 range - Percentage of individuals who did not complete high school is +/- 5% of qualifying SA2 range - Percentage of individuals born in Non-English speaking countries is +/- 5% of qualifying SA2 range - The percentage of children in the bottom 25% in each AEDC domain (health, social, emotional, language and communication) are +/- 5% of qualifying SA2 ranges **Evaluation Plan** ------------------- To explore the population-level effects of the Triple P system, a comprehensive evaluation will be conducted across a three year implementation period, with administrative data analysed for the 3 years prior to implementation and the 12 months following completion of implementation. **1. Administrative Data Access** The research team will work with government departments to acquire Commonwealth and State level administrative data (e.g. child maltreatment rates, non-accidental injury hospital admissions, child and adolescent mental health referral rates, domestic violence call-outs). The research team will only have access to a de-identified dataset that contains the relevant variables to the research questions under investigation. Additionally, the research team will have access to data regarding the reach of the reach of the Triple P System within the intervention communities via Triple P International (TPI). This data will be aggregate level data, including: the number of parents who have attended a Triple P program; the number of programs implemented at the LGA and SA2 levels; the number of practitioners delivering Triple P within the LGAs; and the number of programs by Level of Triple P. TPI does not collect any identifying information on participating families and they will not disclose individual agency participation data to the Research Team. **2. Brief Triple P Participant Survey** Participants at Triple P programs will be asked to complete an anonymous brief participant survey designed to capture characteristics of parents who participate in the program (e.g., parent age and gender; number of children, suburb in which they live). Demographic data collected will be used to assist with tracking the number of parents across the implementation local government areas and intervention SA2s who have participated in Triple P, the type of program variant (e.g., group or seminar) and whether Every Family is effectively recruiting families from the intervention SA2’s. The survey will be anonymous and voluntary and takes less than 5 minutes to complete. Participants will be provided with a plain language statement and the survey as they enter the session and requested to return it to the practitioner at the end of the session (if they agree to do so). Informed consent is implied via the return of the form to the practitioner. Parents who choose not to complete the survey will still be able to participate in the Triple P program without any negative consequences. Data from forms will be entered and stored into a secure online database and hard copies will be scanned and destroyed and will only be accessible by members of the research team. NOTE: Please refer to the Materials component for a copy of the Brief Triple P Participant Survey. **3. Community Survey of Parents: Raising children in Your Neighbourhood Survey** The Raising Children in Your Neighbourhood Survey (RaCYN) will be conducted at two time-points to enable evaluation of the reach of the Triple P program over a two year period (2018 -2020). The survey will evaluate community knowledge and participation in parenting support programs, with specific reference to Triple P and will also be used to evaluate community perceptions of the degree to which parents are supported in their parenting role, the type and severity of child social, emotional and behavioural difficulties experienced in the community, approaches to parenting and community perceptions of the community as a parent and child friendly environment. The survey will be conducted across Queensland and another Australian state in order to allow within and between state comparisons to the three Local Government implementation areas, with a specific focus on the 32 intervention SA2s in Queensland. The survey will be conducted at two time-points: T1 (early implementation phase, 2018) and T2 (following completion of the implementation phase (2020). Within Queensland comparisons will be between the three Every Family LGA implementation areas (Ipswich, Toowoomba and Moreton Bay) and also to other LGA’s across Queensland without the systematic approach to implementation of Every Family. Between state comparisons will specifically focus on comparing the 32 Queensland intervention SA2s with the 32 matched control SA2s in another Australian state. These comparisons will contribute to the assessment of the extent to which Triple P was present in both intervention and control areas and the extent to which community perceptions change over time. The RaCYN survey will provide information on whether parenting support information and programs are reaching families within target communities, and gains information about parents’ beliefs about the level of support and trust they have in their community. This information will be used to inform the overall study findings including whether the Every Family project has been associated with shifts in community awareness and participation in parenting support and perceptions of their community over time. NOTE: Please refer to the Materials component for a copy of the RaCYN survey. **Participants** Targeted participants will be all households with children under 18 years old, living in Queensland and the comparison state, with a specific focus on households with children aged 3 to 8 years. According to 2016 ABS census data there are approximately 250,184 families in QLD and 390,209 families in the comparison state with children aged 3 to 8 years. It is expected that around 5-15% of households with children aged 3 to 8 years will complete the survey, meaning approximately 32,020 to 96,059 parents will participate in the survey across both states. In addition to promotion across both states, targeted recruitment will occur within intervention and control communities. There are approximately 21,825 families in QLD intervention communities and 23,312 families in control communities with children aged 3 to 8 years. It is expected that around 10-15% of these families will participate meaning 4,514 to 6,770 families within intervention and control communities will participate. **Method** The anonymous Raising Children in Your Neighbourhood Survey (RaCYN) is a repeat cross-sectional online survey to be carried out at two time-points (2018 and 2020). A multi-method approach to recruitment will be adopted to ensure that an adequate and representative sample is recruited to enable statistical analysis and generalization of results. **Recruitment** To ensure that analysis is possible at the SA2 level a multi-method approach to recruitment will be adopted and in which recruitment will be guided by quotas designed to ensure representativeness of the sample. Participants will be required to be a parent/caregiver. ABS census data regarding highest education level will be used as an indicator of social disadvantage and to establish quotas to ensure representativeness of socio-economic status. Additionally, we will aim to recruit a representative number of parents who have and who have not attended Triple P. As our aim is for approximately 25% of parents to participate in Triple P by the end of the project will we aim to recruit approximately 75-80% respondents who have not participated in the program. Three recruitment methods will be used: 1. School and community based recruitment: Promotional material (electronic and hard copy) for the survey will be distributed to schools, community agencies (e.g., local business, community centres, non-government organisations), medical clinics, sporting groups and state and local government representatives. Organisations will be asked to promote the survey to their consumers via newsletters, social media, distribution of flyers and as appropriate via directly telling parents about the survey. 2. Media: Localised media releases about the survey will be prepared in collaboration with UQ’s communication and media team and distributed to print, radio and TV media sources. Media responses will be conducted by Dr Kylie Burke (Project Director) or Professor Matt Sanders (Chief Investigator) as required. In addition, geo-targeted social media posts will be used to promote the survey and requests will be made to relevant parenting and child related blogs, websites and social media accounts to promote the survey. 3. Household surveying: To increase participation by families who are most disadvantaged, face-to-face surveys will also be conducted in the intervention and comparison SA2’s. In consultation with local council representatives and local agencies, a select number of streets will be identified and targeted to carry out the survey as a face-to-face household survey. Targeted streets will be those residing in the most disadvantaged areas. The Index of Community Socio-Educational Advantage (ICSEA) assigned to each school and the distribution of students from the bottom to top quarter of educational disadvantage to advantage will also be used to guide street selection in areas surrounding schools. The ICSEA provides a measure of the socio-educational composition of a school’s student body based on parent occupation, parent education level, locality, proportion of Indigenous students, and proportion of parents with lower education levels and a language background other than English (LBOTE). **Measures** The RaCYN survey is designed to measure factors such as awareness of Triple P and other parenting supports, child social, emotional and behavioural difficulties, parenting, and social cohesion at the community level (see Appendix 3 for full RaCYN survey). Where possible existing scales and measures of outcomes of interest were used. Five existing published scales were included: the Intergenerational Closure Scale (Sampson, Morenoff & Earls, 1999), the Social Cohesion and Trust subscale of the Collective Efficacy Scale (Sampson, Raudenbush & Earls, 1997), the Parental Empowerment subscale of the Parent Empowerment and Efficacy Scale (Freiberg, Homel & Branch, 2014), the Parenting and Family Adjustment Scale (Sanders et al, 2014), and the “Me as a Parent” scale (Hamilton, Matthews & Crawford, 2014). If no existing scales were found, then the project team developed new items or adapted items. Table 1 shows the topic areas covered by the survey along with the question wording, the origins of the questions from existing scales and subscales, and the number of items included within a topic area. The survey also contains 16 demographic questions, including: parent age and gender, country of birth, language spoken at home, Indigenous background, ethnicity, family composition, parent educational attainment, parent main activity (including employment, home duties, and studying), and number of children (and their ages). Neighbourhood residential stability was captured by asking how long they have lived in their suburb and whether they own their home. These questions are similar in design to those used by the Australian Bureau of Statistics. In addition, there are three questions asked at the end of the survey that establish how a person heard about the survey and the SA2 of a respondent’s residence. **Procedure** A dedicated webpage will be set up for the survey hosted on the UQ domain. Parents will be able to participate in the anonymous survey by clicking a link that takes them directly to the survey. Interested parents who click the link will be taken to an information form that explains the purpose of the survey in detail, who the survey is for, researcher and support contact details and how to take part. Consent will be implied by completion of the survey. At the end of the survey parents will be offered the opportunity to enter contact details to be entered into a draw to win one of 100 $50 Coles-Myer gift vouchers. *Community Recruitment:* Ethics procedures for conducting research in government schools within Queensland and the comparison state will be followed. This consists of sending a completed “Permission to Advertise in Schools” form for consideration and signing by school principals with the project description and promotional materials. Schools and organisations agreeing to promote the survey at each time point will be provided with an electronic flyer, brochure, newsletter insert and social media material to distribute to potential participants. Organisations may also request hard-copy versions of promotional materials and hard-copy survey packages for distribution. Promotional material will briefly explain the purpose of the survey, who the survey is intended for (i.e. households with children), an offer to go into the draw to win one of 100 $50 Coles-Myer gift vouchers for completing the survey, and a website address to complete the survey online. *Face to Face recruitment* will be conducted by research team members. Pairs of researchers will attend a designated target area. At each house in the area the researchers will introduce themselves and the research project. If no one is home, they will leave a flyer in the letterbox. Interested householders who have a child will be invited to participate in the project. They will be provided with a hard copy of the information sheet that outlines the same information available online. Individuals interested in participating may choose to take a flyer and/or a hard copy of the survey to consider for later completion or may complete the anonymous Parent Survey face-to-face with the researcher at the time of the home visit (or at a time scheduled at the convenience of the parent and either in person or via phone). Participants completing a hard-copy version of the survey will be supplied with a survey package that contains the information sheet, survey, reply paid envelope and separate contact form for prize draw entry. Participation in the survey and the prize draw entry is voluntary. The anonymous survey will take participants approximately 15 - 20 minutes to complete. If participants find any questions upsetting they are free to skip questions. Return of the survey via post, completion in-person, or submission online will be taken as informed consent to participate. If participants wish to seek further assistance they may refer to the researcher’s and support contact details on the information sheet provided. The information sheet and project webpage will provide details of useful help lines and services (e.g., beyondblue, lifeline, parentline). **Planned Analyses** -------------------- Matching techniques will be used to identify control areas to match with the 32 SA2 intervention areas. Once this set of matched communities has been generated generalised linear mixed models (e.g., multilevel models) will be used to assess changes in outcomes before and after the intervention, at different time periods, while controlling for other variables including whether the area is a control or intervention area. These models allow us to model non-linear trends i.e. changes in outcomes over time before and after intervention, and to include control variables that are both fixed and time-varying at the area level.