Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent) and Parent Training Programs that Address Behavior Problems in Children and Adolescents.

Target Population: For parents and caregivers of children and adolescents from birth to 12 years old with moderate to severe behavioral and/or emotional difficulties or for parents that are motivated to gain a more in-depth understanding of positive parenting

For parents/caregivers of children ages: 0 – 12

Brief Description

Level 4 Triple P is one of the five levels of the Triple P - Positive Parenting Program® System which is also highlighted on the CEBC. Level 4 Triple P helps parents learn strategies that promote social competence and self-regulation in children as well as decrease problem behavior. Parents are encouraged to develop a parenting plan that makes use of a variety of Level 4 Triple P strategies and tools. Parents are then asked to practice their parenting plan with their children. During the course of the program, parents are encouraged to keep track of their children’s behavior, as well as their own behavior, and to reflect on what is working with their parenting plan and what is not working so well. They then work with their practitioner to fine tune their plan. Level 4 Triple P practitioners are trained to work with parents’ strengths and to provide a supportive, non-judgmental environment where a parent can continually improve their parenting skills. Level 4 Triple P is offered in several different formats (e.g., individual, group, self-directed, and online). The CEBC evaluated the standard version of Level 4 Triple P as described above and not any other variations (including early teen versions or those for children with developmental delays).

Program Goals:

The overall goal of Triple P - Positive Parenting Program® - Level 4 is:

  • Prevent worsening of severe behavioral, emotional and developmental problems in children and adolescents by enhancing the knowledge, skills, and confidence of parents

Specific expected outcomes include:

  • Increase parents’ competence in promoting healthy development and managing common behavior problems and developmental issues
  • Reduce parents’ use of coercive and punitive methods of disciplining children
  • Increase parents’ use of positive parenting strategies in managing their children’s behavior
  • Increase parental confidence in raising their children
  • Decrease child behavior problems (for families experiencing difficult child behavior)
  • Improve parenting partners’ communication about parenting issues
  • Reduce parenting stress associated with raising children

Essential Components

The essential components of Triple P - Positive Parenting Program® - Level 4 include:

  • Uses developmentally appropriate interventions with a variety of media:
    • Provides a program designed for infants, toddlers, preschoolers and elementary school-aged children, as well as a distinct program for early teens
    • Delivered with a variety of resources (such as parent workbooks, parent DVD collections, practitioner presentations, a self-directed workbook, and an online application) used in session and later in assigned homework to impart information and to provide a parent with practice exercises when at home
  • Uses an explicit self-regulatory framework:
    • Includes principles of:
      • Self-sufficiency
      • Self-efficacy
      • Self-management
      • Problem-solving
    • Parents taught how to monitor their own and their child’s behavior, and asked to set specific and observable goals for change
    • Self-management and self-sufficiency enhanced by having the practitioner prompt the parent to review his or her application of new parenting strategies, reflecting on what they did well in the process (their strengths), and then setting specific goals for any difficulties or challenges they experienced
    • Parent assisted in applying the principles they have learned to solve problems in a self-sufficient manner that leads to more independence
    • Practitioners encouraged to use multiple, relevant examples with families and to create a flexible teaching environment
  • Uses the principles of minimal sufficiency to ensure cost effectiveness:
    • Allows tailoring of intervention intensity to meet individual family needs which helps cost effectiveness
    • Assesses the level of risk the family faces via intake interview, questionnaires, monitoring, and observation of parent-child interaction by practitioner
    • Tailors the level of intensity based on the level of risk and difficulty the family faces (i.e., the higher the risk, the higher the intensity)
    • Administers assessments after completion of Level 4 Triple P to determine if a family needs Level 5
  • Incorporates identifiable program elements to promote generalization and transfer of learning:
    • Uses multiple examples as part of its flexible training philosophy
    • Teaches generalization and maintenance across time, situations, and children
    • Teaches parents strategies for managing high-risk situations (e.g. going shopping) to ensure generalization across contexts
  • Offers and evaluates flexible delivery modalities such as:
    • Individual delivery
    • Group delivery with 8-12 parents
    • Self-directed program delivery, including an online version
    • May be offered in a variety of settings (e.g., home, clinic, school, family resource center)

Parent/Caregiver Services

Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) directly provides services to parents/caregivers and addresses the following:

  • Parents with children with moderate to severe behavior problems (e.g., multiple behavior problems, aggressive behavior, Oppositional Defiant Disorder, Conduct Disorder, learning difficulties), significant difficulty managing these behaviors, lack of positive parenting skills including how to manage the following: stress, mild-moderate depression symptoms, anxiety, anger, parenting partner conflict, and negative attributional thinking 
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: In Level 4 Triple P, the parent(s) and/or caregivers are the main participants; other family members may be asked to join if it fits into the family’s parenting plan. The intention is to empower parents or caregivers to raise children and to become increasingly self-reliant. Children can be involved in the initial phases of intervention for assessment via interview and/or observation. Children are also involved for parent-child interaction observation later in the program.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) includes a homework component:

Homework is an integral part of Level 4 Triple P and is agreed upon in session and reviewed in the following visit as part of the parent learning to self-regulate. Homework could include monitoring of parent behavior, implementation of positive parenting strategies (e.g., behavior charts) and discipline routines, practice sessions with child, viewing videos, reading parent workbooks, problem-solving exercises, and planned discussion with parenting partner.

Languages

Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) has materials available in languages other than English:

Arabic, Berber, Chinese, French, Greek, Japanese, Malay, Portuguese, Romanian, several other languages, Spanish, Swedish, Turkish, Vietnamese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

For individual families, practitioners will need the accompanying parent resources for a given intervention and a space to talk with the parent that is comfortable for the parent (e.g. appropriate level of privacy, etc.). These practitioners will also need equipment to show families DVD clips (e.g., laptop with a DVD, portable DVD player, TV with DVD, etc.). For group interventions, practitioners will need A/V equipment to deliver a PowerPoint as well as show DVD clips to parents. Practitioners will also need a white board or flip chart. Level 4 interventions require a single practitioner/consultant to provide the direct service. However, it is highly recommended that agencies staff their Level 4 Triple P program in order to sustain it. For even the smallest implementations, 4 practitioners are recommended.

Minimum Provider Qualifications

Level 4 Triple P provider training courses are usually offered to practitioners with a post-high school degree in health, education, child care, or social services. In exceptional circumstances this requirement is relaxed when the prospective practitioners are actively involved in “hands-on” roles dealing with the targeted parents, children and teenagers. These particular practitioners have developed, through their workplace experience, some knowledge of child/adolescent development and/or have experience working with families.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Most commonly training is provided onsite with an agency or organization hosting the training. However, Level 4 Triple P also hosts and provides trainings in an Open Enrollment format several times a year for agencies and organizations that do not have a large enough group for an agency-based training. Open Enrollment trainings are conducted in major cities around the U.S., depending on regional demand, and will be posted on the program's website.

Number of days/hours:

Training for Level 4 Triple P standard version is 3 days for training, 1 full day for pre-accreditation 4-6 weeks following training, plus 1/2 day accreditation (per trainee) 6-8 weeks post-training. Training for Level 4 Triple P group version is also a 3-day training course followed by a 1 day pre-accreditation day 4-6 weeks post-training and a 1/2 day accreditation (per trainee) conducted 6-8 weeks after training. Training cohorts are comprised of 20 trainees with one Level 4 Triple P trainer for both the training and pre-accreditation days. These cohorts are divided into smaller groups during the final accreditation procedures. The actual training hours for each training day are 9:00 am - 4:30 pm, including two 20-minute breaks and a 45-minute lunch break, most often catered onsite by the hosting agency. The self-directed and online versions of Level 4 Triple P do not have training courses. It is recommended, however, that agencies that provide these versions have trained providers available to answer parents’ questions.

Implementation Information

Since Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) as listed below:

Support using the Implementation Framework is inclusive of several tools designed to support agencies in the successful adoption of Triple P. Examples of these documents include:

  • Organizational Readiness Checklist
  • Organization Selection/Fit Form
  • Practitioner Selection/Fit Form
  • Community Assessment/Implementation Milestones Checklist
  • Quality Assurance Checklist
  • Evaluation Checklist
  • Shared Learning Network Planning

The Triple P Implementation Tools are provided with support from an Implementation Consultant at no cost for agencies planning to adopt Triple P. Please email contact.us@triplep.net for more information related to the Triple P Implementation Framework.

Formal Support for Implementation

There is formal support available for implementation of Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) as listed below:

Triple P America employs Implementation Consultants who are available from point of interest through the implementation process, providing technical support, coaching and consultation. This includes supporting organizations in the implementation planning process and sharing of Triple P implementation tools is included for agencies/jurisdictions adopting Triple P. For complex initiatives, organizations without experience in implementing manualized practices, or organizations without the capacity to support multi-organizational implementation, Triple P America can provide additional implementation support at an additional cost.

Fidelity Measures

There are fidelity measures for Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) as listed below:

Triple P has three quality assurance/fidelity checks built into its implementation framework:

  1. Session Checklists – Each intervention has a session checklist which assists practitioners in implementing the service as intended. Organizations have the flexibility to utilize these instruments as self-assessments or in more formal quality assurance procedures. These can be provided for agencies interested in adopting Triple P.
  2. Accreditation of Practitioners – Completed within the context of a Triple P Provider Training Course, this establishes baseline competence of all practitioners and certifies them as being able to implement the program as intended. The accreditation process has two steps: obtaining a passing score on a written exam and displaying competence in parent consultation skills as scored by an accredited Triple P trainer through direct observation or DVD submission. Procedures are in place to help and “recycle” practitioners to master the intervention when they do not pass accreditation.
  3. Peer Support Networks - A crucial element in implementation sites involves the adoption of a self-regulatory framework and the use of the Peer Assisted Support and Supervision (PASS) model of quality assurance. During PASS sessions, practitioners are expected to present cases, obtain feedback from other qualified practitioners, and continue to supplement their skills with continuing education. The PASS manual and checklist are available to trained practitioners through the Triple P Provider Network.

Other quality assurance and fidelity checks are possible to implement and Triple P America implementation consultants will work with local agencies to craft a plan that is consistent with local oversight agency procedures. Please email contact.us@triplep.net for further information on measures of fidelity.

Implementation Guides or Manuals

There are implementation guides or manuals for Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) as listed below:

Triple P has two levels of implementation tools available. Implementation Consultants can provide support to organizations to develop their own handbook of implementing Triple P, using the tools and processes in the Implementation Framework to provide a context specific guide for those responsible for coordinating the implementation of Triple P at that organization or region. For the direct service provider, each level of Triple P includes a Practitioner Manual with step-by-step guidelines for successful delivery of Triple P.

Tools associated with the Implementation Framework are provided in conjunction with support from a Triple P Implementation Consultant for agencies or jurisdictions interested in adopting Triple P. The Triple P Practitioner Manuals are provided as part of the Triple P training. Please email contact.us@triplep.net from more information related to the Triple P Implementation Framework. The relevant Triple P Practitioner Manual is provided to practitioners when they attend a Triple P Provider Training Course.

Research on How to Implement the Program

Research has been conducted on how to implement Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) as listed below:

  • Aldridge, W. A., II, Murray, D. W., Prinz, R. J., & Veazey, C. A. (2016). Final report and recommendations: The Triple P implementation evaluation, Cabarrus and Mecklenburg counties, NC. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.
  • Asgary-Eden, V., & Lee, C. M. (2012). Implementing an evidence-based parenting program in community agencies: What helps and what gets in the way? Administration and Policy in Mental Health and Mental Health Services Research, 39(6), 478-488.
  • Breitkreuz, R., McConnell, D., Savage, A., & Hamilton, A. (2011). Integrating triple P into existing family support services: A case study on program implementation. Prevention Science, 12(4), 411-422.
  • Mazzucchelli, T. G. & Sanders, M. R. (2010). Facilitating practitioner flexibility within evidence-based practice: Lessons from a system of parenting support. Clinical Psychology: Science and Practice, 17(3), 238-252. doi:10.1111/j.1468-2850.2010.01215.x
  • McWilliam, J., Brown, J., Sanders, M. R., & Jones, L. (2016). The Triple P implementation framework: The role of purveyors in the implementation and sustainability of evidence-based programs. Prevention Science, 17, 636-645.
  • Sanders, M. R., Prinz, R. J., & Shapiro, C. J. (2009). Predicting utilization of evidence-based parenting interventions with organizational, service-provider and client variables. Administration and Policy in Mental Health and Mental Health Services Research, 36(2), 133-143.
  • Shapiro, C. J., Prinz, R. J., & Sanders, M. R. (2012). Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment the Triple P-Positive Parenting Program. Child Maltreatment, 17(1), 86-95.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Numerous studies have been conducted of Level 4 Triple P. Two meta-analyses, which the CEBC does not include in the review process, have been conducted on Level 4 Triple P:

  • De Graff, I., Speetjens, P., Smit, F., De Wolff, M., & Tavecchio, L. (2008). Effectiveness of the Triple P Positive Parenting Program on parenting: A meta-analysis. Family Relations, 57, 553-566. doi: 10.1111/j.1741-3729.2008.00522
  • De Graff, I., Speetjens, P., Smit, F., De Wolff, M., & Tavecchio, L. (2008). Effectiveness of the Triple P Positive Parenting Program on behavioral problems in children. Behavior Modification, 32, 714-735. doi: 10.1177/0145445508317134

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 articles chosen for Level 4 Triple P are summarized below:

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

Type of Study: Randomized controlled trial
Number of Participants: 305

Population:

  • Age — 3 years
  • Race/Ethnicity — Caucasian
  • Gender — Not specified
  • Status — Participants were families with preschool age children with behavioral conduct problems who were recruited through a community outreach campaign.

Location/Institution: Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of three types of Triple P in treating behavioral conduct problems in a sample of families with preschool age children. Eligible families exhibited at least one risk factor: maternal depression, relationship conflict, single parent household, low family income, or low occupational prestige for the major income earner. Families were randomly assigned to standard Level 4 Triple P, self-directed Level 4 Triple P, enhanced Triple P (Level 5), or a waitlist control group. Standard Level 4 Triple P employed the same materials as the self-directed program, but added active skills training and support from a trained practitioner. Enhanced Triple P included interventions tailored to the needs of each family, including instruction on coping skills, and strategies for partner or social support. Participants were assessed using the Parent Daily Report (PDR), Eyberg Child Behavior Inventory (ECBI), Family Observation Schedule (FOS-R-III), and the Parenting Sense of Competence Scale. Results indicated that the two practitioner-assisted interventions were associated with lower levels of parent-reported disruptive child behavior, lower levels of dysfunctional parenting, and parents reported a heightened sense of competence. Children in the Enhanced Triple P condition showed more reliable improvement, although by the end of the 1-year follow-up all Triple P conditions had achieved similar levels of improvement in disruptive behavior. The practitioner-assisted programs were associated with greater improvement in parent-reported disruptive behavior. The main study limitation was that 1-year outcomes were compared to pretest levels only, not to waitlist controls.

Length of postintervention follow-up: 1 year.

*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.

Type of Study: Randomized controlled trial
Number of Participants: 87

Population:

  • Age — 3 years
  • Race/Ethnicity — Caucasian
  • Gender — Not specified
  • Status — Participants were families with preschool age children with behavioral conduct problems from the Sanders, Markie-Dadds & Bor (2000) sample.

Location/Institution: Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: The study used a subset of children from the Sanders, Markie-Dadds & Bor (2000) sample. Participants in the current study demonstrated ADHD criteria obtained in a clinical interview with mothers. Participants were randomly assigned standard Level 4 Triple P, enhanced Triple P (Level 5), or a waitlist control group. Participants were assessed at intake and post-treatment using the Revised Family Observation Schedule (FOS-RIII), Beck Depression Inventory (BDI), Child Abuse Potential Inventory (CAP), Eyberg Child Behavior Inventory (ECBI), Parent Daily Report (PDR), Parenting Sense of Competency Scale, and the Parent Problem Checklist. Results indicated that participation in both Triple P conditions were associated with lower levels of parent-reported child behavior problems, lower levels of dysfunctional parenting and greater parental sense of competence than the wait-list conditions. Enhanced Triple P was also associated with less observed negative child behavior. These effects were maintained at the 1-year follow-up.

Length of postintervention follow-up: 1 year.

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.

Type of Study: One group pretest-posttest study
Number of Participants: 37 couples

Population:

  • Age — Children: 2-5 years, Adults: 34-37 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — Not stated
  • Status — Participants were parents experiencing marital problems and have children age 2 to 5 years that are displaying behavioral problems.

Location/Institution: Parenting and Family Support Triple P Clinic - Queensland, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study describes the outcomes of two variants of a group parent training program, either Standard Group Level 4 Triple P or Enhanced Group Triple P (Level 5). Measures utilized include the Family Background Questionnaire, Eyberg Child Behavior Inventory (ECBI), Parenting Scale, the Parent Problem Checklist, Depression Anxiety Stress Scales (DASS), Abbreviated Dyadic Adjustment Scale (ADAS), Marital Communication Inventory (MCI), ENRICH Marital Satisfaction Scale (EMS), and the Client Satisfaction Questionnaire (CSQ). Results indicated that there were significant improvements for both conditions, on measures of disruptive child behavior, dysfunctional parenting style, conflict over parenting, relationship satisfaction and communication. Limitations include all reports were based on parent-report only, no waitlist control group, and non-equivalent amount of parent training per conditions.

Length of postintervention follow-up: 3 months.

Zubrick, S. R., Ward, K. A., Silburn, S. R., Lawrence, D., Williams, A .A., Blair, E., Robertson, D., & Sanders, M. R. (2005). Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prevention Science, 6(4), 287-304.

Type of Study: Two group longitudinal design with nonmatched comparison group
Number of Participants: 1,610

Population:

  • Age — 3-4 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were families with preschool age children with disruptive behavior problems who were recruited through the media and professional referrals.

Location/Institution: Metropolitan Health Regions of Western Australia.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of group Level 4 Triple P in addressing disruptive behavior problems in a sample of preschool age children. The intervention group received training through a group version of the Triple P program, followed by telephone support sessions once a week for four weeks. Participants were assessed at intake and at 12- and 24-month follow-ups using the Eyberg Child Behavior Inventory (ECBI), Parenting Scale, Parent Problem Checklist, Abbreviated Dyadic Adjustment Scale, and the Depression Anxiety Stress Scales (DASS). Results indicated that participation in Level 4 Triple P contributed to significant reductions in parent-reported levels of child behavior problems and self-reported levels of dysfunctional parenting over the 2-year follow-up. Positive effects were also found on parent mental health, marital adjustment, and levels of child-rearing conflict. Limitations included significant differences between groups. Comparison group children were somewhat older, more likely to come from blended families and more likely to have mothers with no postschool qualifications. However, comparison group children entered the study with lower average levels of behavior problems.

Length of postintervention follow-up: 2 years.

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(3), 259-275.

Type of Study: Randomized controlled trial
Number of Participants: 63 families

Population:

  • Age — Children: 2-5 years, Parents: 32-35 years
  • Race/Ethnicity — Predominately Caucasian
  • Gender — Children: 40 Male and 23 Female
  • Status — Participants were parents with children with disruptive behaviors recruited through a community outreach campaign.

Location/Institution: Queensland, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined families who were randomly assigned to either self-directed Level 4 Triple P or a waitlist group. Measures utilized include Eyberg Child Behavior Inventory (ECBI), the Parenting Scale (PS), the Parent Daily Report (PDR), Parenting Sense of Competency Scale, (PSOC), Parent Problem Checklist (PPC), Depression Anxiety Stress Scales (DASS), and the Client Satisfaction Questionnaire (CSQ). Mothers in the Level 4 Triple P group reported significantly less child behavior problems, less use of dysfunctional discipline strategies, and greater parenting competence than mothers in the waitlist group. On measures of parental adjustment, there was no significant difference in conditions at post-intervention based on mothers’ reports of depression, anxiety, stress, and conflict with partners over parenting issues. Mothers’ reports at follow-up indicated that gains in child behavior and parenting practices achieved at post-intervention were maintained. Limitations include small sample size, lack of follow-up of waitlist control condition, relying on self-reporting measures to determine success, and generalizability to other ethnic populations.

Length of postintervention follow-up: 6 months.

Sanders, M. R., Bor, W., & Morawska, A. (2007). Maintenance of treatment gains: A comparison of Enhanced, Standard, and Self-directed Triple P – Positive Parenting Program. Journal of Abnormal Child Psychology, 35, 983-998.

Type of Study: Randomized controlled trial
Number of Participants: 305 families

Population:

  • Age — 3 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — 68.3% male
  • Status — Participants were parents of children displaying behavioral problems.

Location/Institution: Queensland, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: The study uses the same sample as Sanders, Markie-Dadds & Bor (2000). This study describes the outcomes of three different variants of the Triple P - Positive Parenting Program. Families were randomly assigned to standard Level 4 Triple P, self-directed Level 4 Triple P, enhanced Triple P (Level 5), or a waitlist control group. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Beck Depression Inventory, the Parent Problem Checklist, the Child Abuse Potential Inventory (CAP), the Diagnostic Interview Schedule for Children–Parent version, a Revised Family Observation Schedule (FOS-RIII), the Parent Daily Report (PDR), Parenting Scale, Parenting Sense of Competency Scale (PSOC), Abbreviated Dyadic Adjustment Scale (ADAS), Depression Anxiety Stress Scales (DASS), Client Satisfaction Questionnaire (CSQ), Sutter–Eyberg Student Behavior Inventory (SESBI), and the Power, Privilege and Prestige Scale. Results indicated at 1-year follow-up there were similar improvements on observational and self-report measures of preschooler disruptive behaviour for enhanced Triple P (Level 5), standard Level 4 Triple P, and self-directed variants of Level 4 Triple P. At 3-year follow-up, each condition showed a similar level of maintenance of intervention effects. Approximately 2/3 of preschoolers who were clinically elevated on measures of disruptive behavior at pre-intervention moved from the clinical to the non-clinical range. Limitations include attrition and generalizability to older age groups of children.

Length of postintervention follow-up: 1 year and 3 years.

Bodenmann, G., Cina, A., Ledermann, T., & Sanders, M. R. (2008). The efficacy of the Triple P – Positive Parenting Program in improving parenting and child behavior: A comparison with two other treatment conditions. Behaviour Research and Therapy, 46, 411-427.

Type of Study: Randomized controlled trial
Number of Participants: 150

Population:

  • Age — 2-12 years
  • Race/Ethnicity — Swiss
  • Gender — 50% Male and 50% Female
  • Status — Participants were married couples with children ages 2 to 12 years who were recruited from the media.

Location/Institution: Switzerland and Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the efficacy of group Level 4 Triple P in a sample of married couples with children. Participants were randomly assigned to a group  Level 4 Triple P intervention group or to a couples coping enhancement training (CCET) comparison group. Participants were evaluated at intake, post-intervention, and at 1-year post-intervention follow-up using the Parenting Scale (PS), Parenting Sense of Competence Scale (PSOC), Parent Problem Checklist (PPC), Eyberg Child Behavior Inventory (ECBI), and the Dyadic Adjustment Scale (DAS). Results indicated that Level 4 Triple P was effective with Swiss families. Mothers of the Level 4 Triple P group showed significant improvements in parenting, parenting self-esteem, and a decrease in stressors related to parenting. Women trained inLevel 4 Triple P also reported significantly lower rates of child’s misbehavior than women of the two other conditions. However, in men only a few significant results were found. Positive effects of the relationship training (CCET) comparison group were somewhat lower than those for the Level 4 Triple P. The main study limitation was the sole reliance on parent self-report for assessment measures.

Length of postintervention follow-up: 1 year.

Hahlweg, K., Heinrichs, N., Kuschel, A., Bertram, H., & Naumann, S. (2010). Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: Is it worth the effort? Child & Adolescent Psychiatry & Mental Health, 4, 1-14.

Type of Study: Randomized controlled trial
Number of Participants: 280

Population:

  • Age — 3-6 years
  • Race/Ethnicity — German
  • Gender — Not specified
  • Status — Participants were families and children ages 3 to 6 years who were recruited from German preschools.

Location/Institution: Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated group Level 4 Triple P administered universally for the prevention of child behavior problems. Participants were randomly assigned to group Level 4 Triple P or to a control group. Participants were assessed at intake, post-intervention, and at 1- and 2-year post-intervention follow-ups using the Kaufman Assessment Battery for Children (K-ABC), German versions of the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5) and Child Behavior Checklist for Ages 6-18 (CBCL/6-18), Caregiver Teacher Report Form (C-TRF), Parenting Scale (PS), Positive Parenting Questionnaire (PPQ), McMahon and Estes Parent-child interaction task, and the Revised Family Observation Schedule (ROS-R-III). Results indicated that at the 2-year follow-up, parents in the Level 4 Triple P intervention reported significant reductions in dysfunctional parenting behavior, and mothers also an increase in positive parenting behavior. In addition, mothers reported significant reductions in internalizing and externalizing child behavior. Single-parent mothers in the Level 4 Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group. Neither mother-child interactions nor teacher ratings yielded significant results. The main study limitation was the sole reliance on parent reports for assessment because behavioral observation and teacher ratings resulted in non-significant findings for two-parent households.

Length of postintervention follow-up: 2 years.

Sanders, M. R., Baker, S., & Turner, K. M. T. (2012). A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early onset conduct problems. Behavior Research & Therapy, 50, 675-684.

Type of Study: Randomized controlled trial
Number of Participants: 116

Population:

  • Age — Children: 2-9 years, Parents: Mean=37 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — 67% Male
  • Status — Participants were children displaying early-onset disruptive behavior difficulties

Location/Institution: Queensland, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of standard Level 4 Triple P online, an eight-module intensive online positive parenting program for parents of children with early-onset disruptive behavior problems, compared with an “internet use as usual” group. Measures utilized include Family Background Questionnaire (FBQ), Eyberg Child Behavior Inventory (ECBI), Strengths and Difficulties Scale (SDQ), Parenting Scale (PS), Parenting Tasks Checklist (PTC), Depression Anxiety Stress Scales (DASS-21), Parental Anger Inventory (PAI), Parent Problem Checklist (PPC), and Client Satisfaction Questionnaire (CSQ). Results at post-intervention assessment, parents receiving the Internet intervention standard Level 4 Triple P online had significantly better outcomes on measures of problem child behavior, dysfunctional parenting styles, parents confidence in their parenting role, and parental anger. Limitations include small sample size, underrepresentation of low income families, and generalization to other ethnic populations.

Length of postintervention follow-up: 6 months.

Heinrichs, N., Kliem, S., & Hahlweg, K. (2014). Four-year follow-up of a randomized controlled trial of Triple P group for parent and child outcomes. Prevention Science, 15(2), 233-245.

Type of Study: Randomized controlled trial
Number of Participants: 280 families

Population:

  • Age — Children: 3-6 years, Mothers: Mean=35 years, Fathers: Mean= 38 years
  • Race/Ethnicity — Not specified
  • Gender — Children: 51% Male, Parents: Not specified
  • Status — Participants were families from 17 preschools/kindergartens.

Location/Institution: Braunschweig, Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of the current investigation was to evaluate the 4-year efficacy of the group-based Triple P (Level 4 Triple P) as a prevention program administered universally. Seventeen preschools were randomly assigned to Triple P (n=11 preschools, 186 families) or a no parenting intervention control group (n=6 preschools, 94 families). Measures utilized include the German version of the Parenting Scale (PS), the Positive Parenting Questionnaire (PPQ), and the German version of the Child Behavior Checklist (CBCL). Results indicate that mothers and fathers from the intervention preschool group reported significant reductions in dysfunctional parenting behavior. Mothers also reported a shallower decline from pre- to post-intervention in positive parenting behavior, which was maintained 4 years later, than mothers in the control group. Fathers from intervention preschools reported a delayed shallower decline in positive parenting during the follow-up than fathers in the control group. In addition, mothers from intervention preschools reported immediate improvement in child behavior problems during the program while mothers from control preschools did not report this immediate change. However, with mothers from intervention preschools reporting more child behavior problems at baseline, the reduction in child behavior problems disappeared by the fourth year. Study limitations included reliance on self-report data only and high attrition rate.

Length of postintervention follow-up: 4 years.

References

Mazzucchelli, T. G., & Sanders, M. R. (2010). Facilitating practitioner flexibility within evidence based practice: Lessons from a system of parenting support. Clinical Psychology: Science and Practice, 17, 238-252.

Sanders, M. R. (2012). Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annual Review of Clinical Psychology, 8, 345–379. doi: 10.1146/annurev-clinpsy-032511-143104

Shapiro, C., Prinz, R.J., & Sanders, M.R. (2012). Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment: The Triple P-Positive Parenting Program. Child Maltreatment, 17(1), 84-93. doi: 10.1177/1077559511424774

Contact Information

Agency/Affiliation: Triple P America
Website: www.triplep.net
Email:
Phone: (803) 451-2278
Fax: (803) 451-2277

Date Research Evidence Last Reviewed by CEBC: September 2015

Date Program Content Last Reviewed by Program Staff: June 2017

Date Program Originally Loaded onto CEBC: April 2013