Mr. Matt Buttery:

I thank the Chair for inviting me today. I am the chief executive of Triple P UK and Ireland and I am also an honorary associate professor at the University of Warwick. I hoped to have an amazing parent, Pamela Gannon, with me, and her equally amazing support from the Tusla team at St. Helena's, but unfortunately, circumstances changed last night. Ms Gannon is very sick and was unable to make it. I am sure Deputy Ellis would testify to the excellent work of St. Helena's and of Better Finglas. Perhaps there could be another opportunity for this committee to hear from them and Ms Gannon, in particular, and the amazing testimony that she can bring. I have some written testimony from her and perhaps I could share it later on.

I will not repeat some of the points that Ms Tyner made but rather introduce Triple P. Triple P, Positive Parenting Program, is a multilevel suite of evidence-based interventions that increase in intensity. They are suitable for children from birth to age 16. Each level of our system can be delivered in a range of formats, including one-to-one, small groups, large groups or self-directed by parents online. This system of parenting and family support interventions is designed to prevent behavioural, emotional and developmental problems in children. It aims to help parents develop a safe, nurturing environment, promote positive, caring family relationships and develop effective strategies for promoting children’s development.

The programme has been developed, researched, and licensed by the University of Queensland in Australia. It is ranked by the United Nations as the world’s most extensively researched family skills training programme, backed by more than 40 years of ongoing research. Our programmes are delivered in more than 41 countries including Ireland. Some 14 of the 17 Triple P programmes, which we have submitted to undergo the rigorous assessment process of the Early Intervention Foundation guidebook have received the coveted 3 evidence standard. This guidebook lists early intervention programmes demonstrated to improve outcomes for children, young people and their families. Only programmes with level 3 or higher can be categorised as evidence-based according to their standards. This means the programme has undergone at least one rigorous randomised control trial, RCT, and a judgment of causality can be made. The intervention itself is making the difference. The guidebook, and the standards of evidence, are being used to deliver the What Works Ireland Evidence Hub, which is expected to go live later this year. Triple P has a proven track record of working with State agencies, such as Tusla and the HSE, and voluntary, community, faith and school sectors. We have been present in Ireland since 2009. Our programmes have been rolled out across the country. More recently we were delighted to be chosen as one of two positive parenting programmes, of which both are here before the committee, to be delivered under the Sláintecare Healthy Communities programme. Everything we do as a community is to improve the life-course outcomes of children. Nothing is more important than the kind of parenting they receive. Childhood is a crucial stage of development for all young people, particularly for children with developmental disabilities. Research shows that among parents of children with developmental disabilities addressing critical factors such as parental stress and behavioural problems early in life can improve the parent-child relationship in the long term.

Good parent-child relationships may mediate the relationship between parental stress and social and behavioural development. Negative parent-child relationships may be particularly damaging to children with developmental disabilities. Targeting these factors may not only dramatically improve the outcomes for children, but also later outcomes for adult life. Parents of children with disabilities are often faced with multiple challenges and difficult parenting situations. It is important for us to consider innovative means of addressing these challenges, specifically with cost-effective, evidenced-based and scalable approaches, which can support all parents of children with disabilities. Parenting programmes may have to take into account that there are children with special needs whose parents need support. Stepping Stones Triple P has been designed specifically for parents of children with additional special needs, with the aim of teaching parents how to encourage healthy behaviour and emotions where there is a developmental disability. This system of interventions, of which Stepping Stones has multiple, provides parents with comprehensive support in managing their child’s behaviour across various settings and with various issues. The focus is on understanding the function of problem behaviour and teaching children new skills that can be used to replace misbehaviour and promote positive development. The programme can be delivered in a range of formats with different levels of intensity, whether that be group, one-to-one, or short, low intervention formats such as seminars. All variations of Stepping Stones have been assessed by the Early Intervention Foundation. In addition to efficacy, the Early Intervention Foundation cost ratings indicate that they are low or medium-low cost to deliver and set up.

Evidence-based parenting programmes work. Research shows that positive parenting programmes like Stepping Stones Triple P can benefit families with children with developmental disability in some of the following ways. They reduce child behavioural and emotional problems, improve parental mental health, reduce conflict over parenting and improve family functioning. They reduce the stress and burden on parents in the longer term and reduce dysfunctional parenting practices. I will turn to the lived experiences of the Stepping Stones positive parenting programme. I would have loved if Pamela Gannon were here to share her experience. However, I also have an example from a large case in Australia, where they took a public health approach to positive parenting of children with a disability. I have a summary of the report, which I would be very happy to circulate to the committee. It is very readable as a summary of a randomised control trial that was done over a number of years.

Between 2012 and 2017, Stepping Stones was offered free of charge in three Australian states to families of children aged two to 12 with developmental disabilities. The programme was chosen by the government as part of its Mental Health of Young People with Developmental Disabilities programme because it was cost effective to deliver. It was flexible to suit the needs of families with a broad range of problems and additional needs and it had been shown to work. The programme was delivered in a range of formats and at differing levels of intensity. Over that time period, approximately 38% of the target population participated in the programme. A significant number of parents - thousands of parents - were able to engage in this programme. An evaluation of the Stepping Stones programme found that child behaviour and parenting skills improved when they participated. A significant decrease in negative child behaviour was shown at three months and maintained at 12 month follow up. Parenting skills improved by becoming more positive and less coercive. Parent stress reduced following the programme. However, it should be said that for those with significant financial hardship that stress was reduced less. Poverty has an impact on top of the challenges of raising a child with a developmental disability. Participating families were helped financially as they were able to take less time off work, and organisations and professionals adopted the programme enthusiastically. I thank the committee once again for this opportunity to speak and I look forward to questions.