Guide to Effective Programs
for Children and Youth

Triple P-Positive Parenting Program

OVERVIEW

The Triple P-Positive Parenting Program (TP) is a behavioral family intervention designed to improve parenting skills and behaviors. Through changing how parents view and react to their children’s behaviors, the program attempts to reduce child behavior problems and teach healthy parenting. A “Families” video aims to address a specific familial issue in a variety of ways including a segment with guidelines and strategies for successful parenting. Multiple experimental evaluations of TP using a waitlist control group have found the program to be effective at reducing child behavior problems, reducing dysfunctional parenting styles, and increasing parental competence.

DESCRIPTION OF PROGRAM

Target population: Parents of preadolescent children from birth to age 12

The Triple P-Positive Parenting Program is a behavioral family intervention designed to teach parents nonviolent child management techniques as an alternative to coercive parenting practices. The program provides parents information about unrealistic or dysfunctional parent cognitions and helps them to understand their children’s behaviors. The program focuses on improving parents’ skills so they are capable of solving problems themselves. The parents in the program are taught self-monitoring, self-determination of goals, self-evaluation of performance, and self-selection of change strategies. The program is organized into five levels. Level 1 provides parents with parenting and self-help information using a media campaign and is designed to target behaviors such as toilet training and independent feeding, but does not include a therapy session. The next level provides a one or two session healthcare intervention targeted at parents of children with mild behavior problems with minimal therapist contact. Level 3 provides four sessions to target behaviors such as temper tantrums and thumb sucking for children with moderate problem behaviors. Level 4 includes information with active skills training. Level 4 targets parents of children with more serious behavior problems and lasts 8 to 10 sessions. This level includes intensive behavioral parent training. Finally, level 5 is designed for families whose parenting difficulties are complicated by other issues. Level 5 includes enhanced behavioral family intervention.

The program also includes a “Families” video series designed to address a specific familial issue in a variety of ways including a segment of guidelines and strategies for successful parenting.

The program teaches parents by using a self-regulation framework for parenting skills where parents have flexibility to choose goals and targets for their child’s behavior. The program also specifically makes an attempt to address parental concerns about cooperation and compliance with children. Finally, the program provides clear models and examples. The program is administered over the course of eight weeks with four weekly group sessions that last two hours each. In addition, participants receive four weekly phone calls that last between 15 and 30 minutes. A series of experimental studies has examined various levels of Triple-P in a number of different populations.

EVALUATION(S) OF PROGRAM

Connell, S., Sanders, M.R., & Markie-Dadds, C. (1997). Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas. Behavior Modification, 21(4), 379-409.

Evaluated population: Participants consisted of 23 preschool children and their families who were randomly assigned to a program or control group (11 in the control, 12 in the intervention). Participants were from rural areas of South East Queensland, Australia. To be included, children had to be in the elevated range of behavior problems according to the Eyberg Child Behavior Inventory.

Approach: Data were collected from participants pre- and post-treatment. Additionally, a four-month follow-up was conducted with mothers. Measures consisted of the Eyberg Child Behavior Inventory and the PDR to measure children’s behavior. The Parenting Sense of Competence Scale was used to examine parenting self-esteem. To determine dysfunctional discipline practices, the researchers used the Parenting Scale. The Depression-Anxiety-Stress Scale was used to measure anxiety, depression, and stress in parents. The researchers also measured customer satisfaction with the intervention.

Results: Participants in the experimental group experienced a significant reduction of child behavior problems. The program also had a significant impact on parenting styles with those in the experimental group scoring higher on measures of parenting style and parenting sense of competence. Further, parenting anxiety and stress was significantly reduced from pretest to posttest. Both mothers and fathers reported a high level of satisfaction with the program. These program influences were present at the four-month follow-up.

Sanders, M.R., Markie-Dadds, C., Tully, L.A., & Bor, W. (2000). The Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68(4), 624-640.

Evaluated population: Participants consisted of 305 families with three-year-old children from Brisbane. The targeted children were from low-income areas with high levels of juvenile crime and unemployment. To be included, children had to be in the elevated range of behavior problems according to the Eyberg Child Behavior Inventory. Additionally, for a family to be eligible for the study they had to have at least one of the following factors of adversity: maternal depression, relationship conflict, low gross family income, and single parent household. The average age of mothers in the study was 31, and the average age of fathers in the study was 34. The average age of children ranged from 40.3 to 41.7 months.

Approach: Participants were randomly assigned into one of four conditions.

Group One received an enhanced behavioral family intervention (EBFI). Participants in the EBFI received a level 5 enhanced Triple P intervention.
Group Two received a standard behavioral family intervention (SBFI). This intervention included a Level 4 standard Triple P intervention.
Group Three received a self-directed behavioral family intervention (SDBFI), which included a Level 4, Self-Help Triple P intervention.
Group Four was assigned to a waitlist condition (WL). In total, 228 families were assigned to the three intervention conditions and 77 families were assigned to the waitlist condition.

Data were collected from participants prior to the start of the program, just after the program ended, and one year after the program ended. Measures consisted of a standardized interview to obtain family background information. Videotaped observations were also made of mother and child behaviors. The videotapes were coded for child behavior problems. Parents completed the Beck Depression Inventory, the Child Abuse Prevention Inventory, the Eyberg Child Behavior Inventory, the Parent Daily Report, the Parenting Scale, the Parenting Sense of Competency Scale, the Parent Problem Checklist, the Abbreviated Dyadic Adjustment Scale, the Depression Anxiety Stress Scales, and the Client Satisfaction Questionnaire.

Results: At pre-test, no significant differences were found on any of the measures. Results of the study at post-test indicated that the program was effective at reducing child behavior problems. Participants in Group One showed significantly less observed negative behavior than participants in Groups Three and Four. Groups Two and Three both showed less negative behavior than participants in Group Four, as well. In addition, participants in Groups One and Two reported greater parenting competence than mothers in Groups Three and Four. There were no significant differences found on measures of parental affect. Overall, participants in the experimental conditions reported satisfaction with the programs. The impact on negative child behavior was present at the one-year follow up; however, the difference between Groups Three and Four was reduced slightly.

Bor, W., Sanders, M.R., & Markie-Dadds, C. (2002). The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attention/hyperactive difficulties. Journal of Abnormal Child Psychology, 30(6), 571-587.

Evaluated population: Participants consisted of 87 families. To be included, children had to be in the elevated range of behavior problems according to the Eyeberg Child Behavior Inventory and mothers had to report six or more symptoms of inattention or hyper-activity- impulsivity for their child.

Approach: Families were randomly assigned to one of three groups. One group was an enhanced behavioral family intervention (EBFI). A second group was a self-directed behavioral family intervention (SDBFI). A third group was a waitlist condition (WL). In total, 26 children were assigned to the EBFI group, 29 students were assigned to the SBFI group, and 32 students were assigned to the WL group. Participants in the EBFI condition received 12 sessions of Triple P and participants in the SBFI condition received 10 sessions of Triple P.

Data were collected from participants before the start of the intervention, at the end of the intervention and at a one-year follow-up. Measures consisted of the Beck Depression Inventory, the Child Abuse Potential Inventory, the Eyberg Child Behavior Inventory, the Parent Daily Report, the Parenting Scale, the Parenting Sense of Competency Scale, Parent Problem Checklist, the Depression Anxiety Stress Scales, and the Client Satisfaction Questionnaire. In addition, the families completed a 90-minute semi-structured interview and a home observation. There were no significant differences between groups at the beginning of the study.

Results: At post-intervention, results of the study indicated that the program was effective in reducing child behavior problems. Children in the EBFI and SBFI groups exhibited lower levels of disruptive behaviors than children in the WL condition. However, there were no differences found between the EBFI and the SBFI groups. The researchers also found significant gains in parenting skills and competence, with the mothers in EBFI and SBFI reporting significantly lower levels of dysfunctional parenting practices and higher parenting satisfaction and competence than participants in the WL condition. Parents in the intervention groups also reported lower levels of conflict over parenting issues than WL parents.

At the one-year follow-up, most of the gains were maintained; however, with regard to the Eyberg Child Behavior Inventory, there were no significant differences at the one-year follow up.

Leung, C., Sanders, M.R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.

Evaluated population: Participants consisted of 69 parents whose children were between 3 and 7 years old in Hong Kong. Children attended maternal and child health centers and child assessment centers for service. The average age of children was 4.2 and the mean age of the parents was 39.4

Approach: 33 parents were randomly assigned to the Triple P-Positive Parenting Group (TP), and 36 parents were assigned to a waitlist group (WL). Data were obtained using questionnaires completed by the participants at pre- and post-intervention. To measure problem behaviors of children, the researchers used the Parent Daily Report and the Strength and Difficulty Scale. To measure the perceived level of disruption that children caused, the researchers administered the Eyberg Child Behavior Inventory. The Parenting Scale was used to determine parenting styles. The researchers measured parental competence using the Parenting Sense of Competence Scale. The Parent Problem Checklist was used to determine conflict between partners over childrearing and the Relationship Quality Index was used to determine marital/relationship satisfaction. Finally, to determine satisfaction with the program, the Client Satisfaction Questionnaire was used. At the beginning of the study, there were no significant differences between the experimental and control groups.

Results: TP was effective in reducing child behavior problems. The effect sizes were -.97 and -.91. The researchers also found that there were differences in parenting behavior. Specifically, parents in the TP group had significantly reduced dysfunctional parenting.

Ireland, J.L., Sanders, M.R., & Markie-Dadds, C. (2003). The impact of parent training on marital functioning: A comparison of two group versions of the Triple P- Positive Parenting Program for parents of children with early-onset conduct problems. Behavioural and Cognitive Psychotherapy, 31,127-142.

Evaluated Population: The sample consisted of 37 couples with children between ages 2 and 5. Participants exhibited clinically significant levels of marital conflict and reported concerns about the management of their child’s behavior. The average age of the mothers in the study was 34, and the average age of the fathers was 37. A majority of the sample was Caucasian, and the average age of the children ranged from 3.5 to 3.8.

Approach: Participants were randomly assigned to one of two groups. One group received a standard version of Triple P (SGTP), and the other group received an enhanced version of Triple P (EGTP). The SGTP group received 4 two-hour group sessions and 4 15 to 30-minute follow-up telephone calls. While the EGTP group received the intervention the SGTP group received two additional 90-minute group sessions on Partner Support. The Standard Group Triple consisted of 19 couples, and 18 couples were in the Enhanced Group Triple P. Data were collected from participants before the intervention, after the intervention, and at a three-month follow-up.

Measures consisted of the Eyberg Child Behavior Inventory, the Parenting Scale, the Parent Problem Checklist, the Depression Anxiety Stress Scale, the Abbreviated Dyadic Adjustment Scale, the Marital Communication Inventory, the ENRICH Marital Satisfaction Scale, and the Client Satisfaction Questionnaire. At the beginning of the intervention, there were no significant differences between groups on any of the measures except the Parenting Scale. To control for this initial difference, the researchers used the Parenting Scale as a covariate.

Results: With regard to child behavior, while both groups experienced a reduction in disruptive child behaviors, children in the EGTP group were less disruptive than children in the SGTP group. Further, parents in both groups experienced a reduction in conflicts over parenting and an increase in relationship satisfaction and communication. However, the intervention did not have an impact on parenting skills or parental adjustment. Most initial treatment effects were sustained at the 3-month follow-up.

Sanders, Mathew R., Montgomery, Danielle T., Brechman-Toussaint, Margaret L. (2000). The Mass Media and the Prevention of Child Behavior Problems: The Evaluation of a Television Series to Promote Positive Outcomes for Parents and their Children. Journal of Child Psychology and Psychiatry. 41(7), 939-948.

Evaluated population: 56 mothers with children between 3-8 years old, who were living in Australia. To be eligible the child needed to have no chronic illness and not be in treatment for behavioral or psychological problems.

Approach: Mothers were recruited through media releases in newspapers and through brochures distributed in kindergartens, pre-schools, and child care centers. They were randomly assigned to a treatment (TV) condition or a wait-list condition. Mothers completed the Eyberg Child Behavior Inventory, the Parenting Scale, the Parenting Sense of Competence Scale, Depression-Anxiety Scales, the Parenting Problem Checklist, and the Abbreviated Acceptability Rating Profile prior to implementation.

Each mother was provided the set of 12 videos along with informational tip sheets tailored to the content of each video. Mothers were given 6 weeks to watch all 12 videos.

Mothers in both the TV and control conditions completed the previous set of measures 6 weeks after random assignment. The experimental set of mothers also completed them at a 6-month follow-up (there was no follow-up on the control group because they were given the tapes to watch after the second round of data collection).

Results: Researchers found that mothers in the TV condition reported fewer behavior problems than mothers in the control group. At pre-intervention, 42.9% of the children in the experimental group had ECBI behavior scores in the clinical range but only 14.3% did at post-intervention and only 9.5% at the 6 month follow up. However, there were was no significant differences on the intensity measure of the ECBI. The only other significant difference between groups was found on the PSOC (parental competence index). Mothers in the TV condition reported a higher level of competence post-intervention than mothers in the wait-list group.

SOURCES FOR MORE INFORMATION

Link to program curriculum: http://www.triplep-america.com/

References

Bor, W., Sanders, M.R., & Markie-Dadds, C. (2002). The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. Journal of Abnormal Child Psychology, 30(6), 571-587.

Leung, C., Sanders, M.R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.

Program categorized in this guide according to the following:

Evaluated participant ages: Parents of children ages 3-7 / Program age ranges in the Guide: 0-5, 6-11, 12-14

Program components: clinic-based, provider-based, or miscellaneous; community or media campaign; parent or family component

Measured outcomes: behavioral problems

Program information last updated 3/14/07