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Program Profile: Triple P – Positive Parenting Program

Evidence Rating: Effective - One study Effective - One study

Date: This profile was posted on June 08, 2011

Program Summary

This is a comprehensive parent-training program designed to enhance parental competence and prevent or alter dysfunctional parenting practices. By enhancing parenting practices, the program seeks to reduce family risk factors for child maltreatment and children’s behavioral and emotional problems. The program is rated Effective. There were statistically significant reductions in substantiated child maltreatment cases, out-of-home placements, and child maltreatment injuries.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Program Theory
Triple P – Positive Parenting Program is a comprehensive parent-training program with the purpose of reducing child maltreatment and children’s behavioral problems. It is built upon a public health approach and as such was designed to treat large populations. The five core principles taught to parents are:
  • Ensure a safe and engaging environment.
  • Promote a positive learning environment.
  • Use assertive discipline.
  • Maintain reasonable expectations.
  • Take care of oneself as a parent.
It is through these core principles that parents learn how to engage in positive and supportive parenting. The first step is getting past the stigma that some parents need help and training in how to be effective parents. The second step is giving them the proper tools and knowledge to raise healthy children.

Program Activities/Target Population
The Triple P system has five intervention levels of increasing intensity and narrowing population reach. Any family with at least one child from infant to 12 years of age is eligible for any of the five programming levels; parents determine for themselves how much help they require.

There are differing program activities at each level of the intervention:

Universal Triple P, or Level 1. This intervention uses a media campaign to reach out to parents who are seeking help. The goal is to destigmatize parent training and make effective parenting strategies available to all families who want to use them. The media campaign uses advertisements in local radio and newspapers, newsletters sent to schools, and mass mailings to families in the intervention area. These messages contain some tips and guidelines for parents, but they are primarily a means of getting the word out about Triple P and upcoming parent training seminars.

Selected Triple P, or Level 2. Level 2 builds upon the first level of intervention but narrows the focus of the programming. The intent here is to normalize parenting interventions and let parents know it is acceptable to ask for help. The programming is primarily targeted at parents who are dealing with minor behavior problems or smaller issues that do not require intensive intervention. There are two delivery options for this intervention: brief consultation with individual parents and parenting seminars delivered to large groups of parents. The brief consultations involve one or two meetings lasting about 20 minutes and the other delivery format consists of three 90-minute sessions aimed at large populations of parents. The seminars are independent of each other, so parents can attend one out of the three or the whole set and still receive some benefit. As with the brief consultations, each delivery method is another avenue for parents to become familiar with Triple P and, if they feel they need it, inquire about more intensive levels of help and parent training.

Primary Care Triple P, or Level 3. Primary Care Triple P increases the intensity of intervention. This level is appropriate for families experiencing common behavior problems. Advice and information are paired with active skills training and effective parenting strategies. Families with infants, toddlers, and preschoolers will benefit the most from this level of assistance and training. The delivery format is four 20-minute consultations that incorporate active skills training and parenting tip sheets that cover common developmental issues (i.e. potty training) and behavioral problems.

Standard and Group Triple P, or Level 4. This level of intervention is targeted at populations of children who have detectable problems which may not be clinically diagnosed and at parents who are struggling with child-rearing challenges. Parents receive a variety of child management skills and advice on how to use these skills at home and in their communities. There are two delivery formats at this level of intervention. The first is 10 sessions, lasting about 90 minutes each, with individual families. These sessions incorporate skills training and observation periods at the home. The second format is given to large groups, and includes eight sessions. Five of these are 2-hour sessions that allow parents to learn through observation, discussion, practice, and feedback. There are also three 15- to 30-minute follow-up sessions done by telephone that give additional support to parents as they apply what they have learned at home.

Enhanced Triple P, or Level 5. This is an optional version of level 4 that is addressed to parents that are in need of more serious intervention or are dealing with major behavioral problems. This level of programming has additional modules on partner communication, mood management, stress-coping skills, and addressing parent–child issues.

Evaluation Outcomes

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Study 1
Substantiated Child Maltreatment Cases
Prinz and colleagues (2009) found that participation in the Triple P Parenting program resulted in a statistically significant reduction in substantiated child maltreatment cases for the treatment group, compared with the control group, at the end of the 2-year intervention.

Out-of-Home Placements
There was a statistically significant reduction in out-of-home placements for the treatment group, compared with the control group, at the end of the 2-year intervention.

Child Maltreatment Injuries
There was a statistically significant reduction in the number of hospitalizations or emergency room visits for injuries resulting from child maltreatment for the treatment group, compared with the control group, at the end of the 2-year intervention.
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Evaluation Methodology

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Study 1
Prinz and colleagues (2009) used a stratified random assignment of the Triple P program to 18 medium-sized counties in a southeastern state. The counties selected were carefully controlled for population, poverty rate, and child abuse rate. Counties ranged in size from 50,000 to 175,000 residents and in structure from rural to semi-urban. Very small and large counties were excluded, as it was deemed that small counties would not have a sufficient population to implement the program or to detect effects, and that large counties would account for too much of the overall variance in results. The counties included in the study had suffered significant reductions in their family services, and there was no evidence that they had ever been exposed to Triple P System or any other large-scale intervention program.

The nine treatment counties received the Triple P system and the nine control counties received services as usual. At baseline, there were no significant differences between intervention and control counties in terms of population size, percentage of population in poverty, racial composition, and child maltreatment measures. Treatment counties were 31.4 percent African American, had 21.2 percent of children (birth to 17) living in poverty, and had a child maltreatment rate of 10.82 over the 5-year prerandomization period. Control counties were 30.8 percent African American, had 21.4 percent of children (birth to 17) living in poverty, and had a child maltreatment rate of 11.40 over the 5-year prerandomization period.

Randomization was done at the county level; therefore, estimating how many families received the Triple P intervention was difficult. The researchers used a telephone survey of Triple P service providers to gauge how many families were served. Based on the survey results, it was estimated that between 8,883 and 13,560 families participated in some aspect of the Triple P System. It was also estimated that 71 percent to 75 percent of families received levels 2 and 3 of the intervention, while the remainder received level 4 and above.

The follow-up period was 2 years, at which point three indicator measures were used to determine the prevention of child maltreatment: substantiated child maltreatment, child out-of-home placements, and hospitalizations or emergency room visits for child maltreatment related injuries. As the unit of analysis was counties, these measures of child maltreatment were measured at the county level.

Researchers conducted preliminary analyses of the three selected measures for 5 years prior to this current study period. This was done to determine if the two groups of counties, treatment and control, differed significantly or had any noticeable trends in child maltreatment prior to the intervention. Each county was subjected to a county cluster by time repeated measures analysis of variance: for both the treatment counties and the control counties, repeated measures of substantiated child maltreatment, child out-of-home placements, and hospitalizations or emergency room visits for maltreatment related injuries were taken for 5 years prior to the Triple P evaluation. All three measures were nonsignificant; the treatment and control counties did not differ significantly in terms of prior child maltreatment for the three indicators examined.

To evaluate the effectiveness of Triple P, T–tests were used to compare the two conditions with respect to the difference in scores before and after the intervention.
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For more information about the cost of implementing Triple P, please visit their website
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Implementation Information

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The Triple P system features a website with resources for both parents and practitioners. The site includes an online form for specifying family or community needs:
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Prinz, Ronald J., Matthew R. Sanders, Cheri J. Shapiro, Daniel J. Whitaker, John R. Lutzker. 2009. “Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial.” Prevention Science 10:1–12.
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Additional References

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These sources were used in the development of the program profile:

De Graaf, Ireen, Paula Speetjens, Filip Smit, Marianne de Wolff, and Louis Tavecchio. 2008. “Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis”. Family Relations 57:553–66.

Fujiwara, Takeo, Noriko Kato, and Matthew R. Sanders. 2011. “Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior, Parenting Style, and Parental Adjustment: An Intervention Study in Japan.” Journal of Child and Family Studies 20:804–13.

Morawska, Alina, Matthew R. Sanders, Elizabeth Goadby, Clea Headley, Lauren Hodge, Christine McAuliffe, Sue Pope, and Emily Anderson. 2011. “Is the Triple P-Positive Parenting Program Acceptable to Parents From Culturally Diverse Backgrounds?” Journal of Child and Family Studies 20:614–22.

Sanders, Matthew R., Carol Markie–Dadds, Lucy A. Tully, and William Bor. 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.” The Journal of Consulting and Clinical Psychology 68:624–40.

Sanders, Matthew R. 2008. “Triple P – Positive Parenting Program as a Public Health Approach to Strengthening Parenting.” The Journal of Family Psychology 22:506–17.

Shapiro, Cheri J., Ronald J. Prinz, and Matthew R. Sanders. 2008. “Population-Wide Parenting Intervention Training: Initial Feasibility.” Journal of Child and Family Studies 17:457–66.

Winter, Leanne, Alina Morawska, and Matthew R. Sanders. 2012. “The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies.” Journal of Child and Family Studies 21:881–90.
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Related Practices

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Following are practices that are related to this program:

Preventive Child Maltreatment Programs
Preventive child maltreatment programs are designed to prevent physical child abuse or neglect by educating expectant and new parents in parenting skills, coping with stressors, and stimulating child development. This practice is rated Effective for preventing child abuse, neglect, and maltreatment.

Evidence Ratings for Outcomes:
Effective - More than one Meta-Analysis Victimization - Child abuse/neglect/maltreatment

Early Family/Parent Training Programs
This practice includes programs that seek to provide families and parents with training and skills to help promote their children’s physical, mental, and social skills. The practice is rated Effective for reducing child problem behaviors for children whose families participated in early family/parent training programs, compared with control group children whose families did not participate in programming.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Juvenile Problem & At-Risk Behaviors - Multiple juvenile problem/at-risk behaviors
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Program Snapshot

Age: 0 - 12

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Hispanic, White

Geography: Rural, Suburban, Urban

Setting (Delivery): Home, Other Community Setting

Program Type: Community Awareness/Mobilization, Parent Training, Children Exposed to Violence

Targeted Population: Children Exposed to Violence, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide, Model Programs Guide, National Registry of Evidence-based Programs and Practices, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention), Top Tier Evidence Initiative

Program Developer:
Matthew R. Sanders
Professor and Director
Parenting and Family Support Centre, University of Queensland
Brisbane, Queensland 4072