Buncombe County Health and Human Services
Buncombe County, punctuated by mountains and bisected by the French Broad River, is home to nearly 250,000 North Carolinians and to the integrated Buncombe County Health and Human Services (DHHS), a system that brings together the Departments of Health and Social Services. Buncombe County DHHS was targeting services to keep children under six safe and applied for funding to bring Triple P (Positive Parenting Program) to their community. Triple P is an evidence-based parenting education and support program designed to increase parents’ skills and self-efficacy for responding positively to common parenting challenges like tantrums or bedtime struggles. The program also helps parents build stronger, healthier connections with their children, a proven protective factor for all five of NC’s prioritized forms of violence. In fact, Triple P has been shown to reduce community rates of some of the most serious childhood issues, including child maltreatment, out-of-home placement, and hospitalization for child maltreatment injuries (Prinz, Sanders, Shapiro, Whitaker, & Lutzker (2009)).
Buncombe County is also home to Innovative Approaches, a robust coalition of individuals committed to systems change to support families of people with special health care needs. According to Triple P Coordinator Deanna LaMotte, the coalition has done a great deal of work to educate the community about Adverse Childhood Experiences, or ACEs. ACEs are a collection of ten types of abuse and family dysfunction, which, when experienced frequently in childhood, have been found to affect a host of long-term health and behavioral outcomes. Buncombe County officials were particularly concerned when Department of Social Services data indicated eighty-percent of children who experienced violence in the county were under 6 years old. Triple P provides tools for parents to improve their abilities to deal with negative consequences of adversity.
Buncombe County is one of numerous communities implementing Triple P across North Carolina. LaMotte oversees the county’s program, conducting outreach to recruit potential Triple P training recipients, whom she describes as anyone who interacts with parents as part of their daily work. This includes social workers, school counselors, Head Start and Early Head Start personnel, among others. Triple P America delivers the training to the providers, who are then encouraged to incorporate the lessons into their work with families. In this way, the program begins to build a network of evidence-based support for parents. One of the many advantages of Triple P is the variety of sessions available to suit the particular needs of parents, from small-group, intensive classes, to brief, one-on-one counseling on specific parenting challenges. To date, 120 people have been trained in Buncombe County. Following the training, LaMotte provides ongoing technical assistance and support to this network of providers, including quarterly meetings to review program data and tips and tools for effective implementation.
Buncombe, like many other N.C. counties, is funded by a three-year grant from the N.C. Department of Health and Human Services to implement Triple P. In addition to LaMotte’s position, the funding pays for all training provided to partner organizations and materials for parents. N.C. is the site of the first successful statewide roll-out of Triple P, and as such, has attracted the attention of the program’s creators. Most N.C. Triple P coordinators across the state are housed in local health departments, infusing a public health, population-based approach to implementation of the program. The public health model, notes LaMotte, ensures that parenting practices are addressed comprehensively, including building key community supports for parents and changing norms around parental help-seeking.
One of the keys to success for Buncombe County, in addition to LaMotte’s determined advocacy, has been tremendous buy-in from the community. LaMotte says there is “no shortage of people who want to take part” and counts over 30 community partners who have helped the program reach more than 600 parents. Data collected for evaluation purposes indicate participating parents are overwhelmingly satisfied with the program (96% rate their experience as good or excellent) and, more importantly, over 90% report their child’s behavior has improved. Many different agencies working with families really begin to collaborate when Triple P is implemented in a community, observes LaMotte. Relationship-building and capacity-building represent welcome byproducts.
LaMotte’s next priorities are to increase the community-wide effort to normalize parental help-seeking and to reach a broader audience of parents. In part because of the program’s strong ties to agencies including the Buncombe HHS and programs like Head Start, most of the Buncombe County parents who have received support through Triple P are low-income. Given that child maltreatment exists in families of all socioeconomic strata, LaMotte believes it is critical that the program reach parents in well-resourced communities, too. In general, she is pleased to be part of an effort that has “raised the level of conversation around parenting” and that ensures “people whose job it is to support families have even better, evidence-based, skills to do that work.”