Triple P-Positive Parenting Program

OVERVIEW

The Triple P-Positive Parenting Program (TP) is a population-based multi-level system of parenting and family support. Through normalizing the challenges of parenting, and changing how parents view and react to their children’s behaviors, the program attempts to reduce child behavior problems and teach healthy parenting. TP uses a combination of universal strategies (e.g., public media messages), and targeted consultations with parents individually and in groups. 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 (although not consistently present at follow-up). In addition, a population-based trial has shown positive results in reducing rates of child maltreatment, child out-of-home placements, and maltreatment-related injuries.

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.

Costs of Triple P have been estimated at less than $12 per child in a hypothetical community of 100,000 families with young children ages 0-8. Costs in this analysis included media and communication strategies, and training for service providers. Given other published estimates of the public costs associated with child maltreatment, it is estimated that the full costs of the program could be recovered in a single year with a 10 percent reduction in the rate of abuse and neglect (Foster, Prinz, Sanders, & Shapiro, 2007).

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.

Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., and Lutzker, J.R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P System Population Trial. Prevention Science, 10, 1-12.

Evaluated population: Families with children ages 0-7 in 18 medium-sized counties (total population sizes between 50,000 and 175,000) in a southeastern U.S. state. Counties ranged from rural to semi-urban.

Approach: Counties were randomly assigned to intervention and control conditions, controlling for population size, poverty rate, and child maltreatment rate. Nine counties received implementation of the Triple P system (Levels 1-5) among their service providers (including those in working in family support services, social services, preschool and child-care settings, elementary schools, non-governmental organizations, and health care providers). The nine control counties experienced “services as usual.”

Measures were three population indicators: substantiated child abuse and neglect; child out-of-home placements; and child hospitalizations and emergency-room visits due to child maltreatment injuries. All three indicators were calculated as annual rates per 1,000 children ages 0-7.

Results: Overall, intervention counties showed significant, positive impacts on all three outcome measures, controlling for pre-intervention rates, compared with the control counties. Between pre- and post-intervention assessments, rates on all three population indicators increased in the control counties. In contrast, in the intervention counties, rates of out-of-home placements and child maltreatment injuries significantly declined. The rate of substantiated child maltreatment cases increased in the intervention counties, but at a slower rate than in the control counties.

Markie-Dadds, C. & Sanders, M.R. (2006). Self-directed triple p (positive parenting program) for mothers with children at-risk of developing conduct problems. Behavioural and Cognitive Psychotherapy, 34, 259-275.

Evaluated population: Participants consisted of 63 families with a pre-school age child. To be included, the following criteria had to be met for each family: 1) the target child was between ages 2 and 5; 2) mothers reported concern about the child’s behavior; 3) there was no evidence of significant health impairment or a developmental disorder for the child; 4) the child was not regularly seeing a professional or agency, or utilizing medication for behavior problems; 5) parents were not receiving psychological therapy at the time of the study, were not intellectually disabled, and reported that they could read a newspaper without assistance; and 6) child disruptive behavior was in the elevated range on the Eyberg Child Behavior Inventory, as reported by mothers. On average, parents in the sample were Caucasian, fell in the mid-range on measures of socioeconomic status, and had two children (including the target child) in their family. Eighty-four percent of parents were married or in a de facto relationship, and 63 percent of the target children were male.

Approach: Participants were randomly assigned to one of two conditions: Self-directed Triple P (SD, N=32 families) or waitlist (WL, N=31 families). Families in the SD condition were assessed at pre-intervention, immediately upon completion of the intervention program (approximately 17 weeks after pre-assessment), and at a 6-month follow-up. Families in the WL condition were assessed at pre-intervention, and then had no contact with the research team until the post-intervention assessment at 15 weeks. Data were collected on disruptive behavior, dysfunctional parenting discipline styles, parent competency, interparental conflict over raising children, and parental affect.

Results: Participants in the SD-intervention group experienced a significant reduction in disruptive child behavior. The intervention program also had a significant impact on parenting styles and sense of competence, with significant differences existing between conditions on over-reactivity, satisfaction, and efficacy. No significant differences were found between the SD and WL conditions at post-intervention for parental affect, or levels of interparental conflict. There were also no significant differences found between post- and follow-up assessments of child behavior and the parenting scale, indicating that gains from the intervention program in these areas were maintained at 6-months. However, a significant change was found for parental competency, with a notable decline in reported levels of satisfaction and efficacy from the post-assessment to follow-up. Using the Reliable Change Index, clinically reliable improvements in behavior were found for 30 percent of children in the SD condition at post-intervention, and 23 percent at the 6 month follow-up. None of the children in the WL condition demonstrated reliable improvements.

Morawska, A. & Sanders, M.R. (2006). Self-administered behavioral family intervention for parents of toddlers: Part I. efficacy. Journal of Consulting and Clinical Psychology, 74, 10-19.

Evaluated population: Participants consisted of 126 families living in the metropolitan area of Brisbane, Australia, who reported concerns over their toddlers’ (age 18-36 months) behavior. Families were excluded from the study if the target child had a chronic illness and/or disability, if parents were already utilizing professional help for child behavior, if parents were receiving therapy/counseling, or if parents were hearing impaired and/or intellectually disabled. In the qualifying sample, similar numbers of boys and girls were present, with an average age of 26 months. The average age of mothers was 33 years and 35 years for fathers, with 86 percent of children living with parents who were married.

Approach: Qualifying participants, who completed the initial assessment package, were randomly assigned to either the self-directed behavioral family intervention (SD-BFI, N=42), the telephone-assisted self-directed behavioral family intervention (TASD-BFI, N=43), or the wait-list control group (WLC). All three groups were assessed at pre-intervention and post-intervention (10 weeks). Both intervention groups received the same program materials, but the TASD-BFI group received weekly telephone consultations, initiated by the clinician. Data were collected on child behavior, parent discipline styles, parent confidence, parents’ abuse potential, interparental conflict, marital relationship quality, and parental affect. The researchers also videotaped 30-minute home observations of mother-child interactions, which were then coded for child behavior problems and parent behavior.

Results: Significant reductions in intensity and number of child behavior problems were found for participants in the intervention conditions at post-test. The intervention also had significant impacts on parenting styles, competence (satisfaction with parenting role), and abuse potential. These effects were maintained at the 6-month follow-up.

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.

Foster, E. M., Prinz, R. J., Sanders, M. R., and Shapiro, C. J. (2007). The costs of a public health infrastructure for delivering parenting and family support. Children and Youth Services Review, 30. Published online November 13, 2007.

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.

Morawska, A. & Sanders, M.R. (2006). Self-administered behavioral family intervention for parents of toddlers: Part I. efficacy. Journal of Consulting and Clinical Psychology, 74, 10-19.

KEYWORDS: Children (3-11), Community-based, Clinic-based, Parent or family component, Parent Training/Education, Community or Media Campaign, Behavioral Problems, Child Maltreatment, Skills Training, Family Therapy, Other Mental Health, Depression, Anxiety, Asian, Counseling/Therapy, Cost, Manual

Program information last updated 4/5/12

		© Child Trends 2004