Triple P – Positive Parenting Program® – Level 3 Primary Care (Level 3 Triple P Primary)

Parents or caregivers of children ages 0-12 years with mild-moderate emotional and behavioral concerns

For parents/caregivers of children ages: 0 - 12

Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary Care) is one of the interventions within the Triple P - Positive Parenting Program® System (System Triple P) which is designed to help parents learn strategies to promote social competence and self-regulation in children as well as decrease problem behavior. Level 3 Triple P Primary Care is typically delivered as 1-4 brief, individual sessions with parents. Parents set personal goals, develop their own parenting plans, and learn to use positive parenting strategies to encourage children to learn the skills and competencies they need. Level 3 Triple P Primary Care is designed as brief, early intervention strategies to be offered by those in a community in regular contact with families of children and may include such settings as health care clinics, schools or early childhood education programs, childcare facilities, community libraries, and/or by other providers in various family-serving community agencies. One of the other Level 3 Triple P interventions, Triple P - Positive Parenting Program® - Level 3 Discussion Group, has been rated a 2 – Supported by Research Evidence on the CEBC Scientific Rating Scale and Triple P - Positive Parenting Program® - Level 4 (Level 4 Triple P) has been rated a 1 – Well-Supported by Research Evidence on the same scale.

Triple P America
Triple P America

• http://www.triplep.net
• Email: contact.us@triplep.net
• Phone: (803) 451-2278

The goals of Level 3 Triple P Primary Care are:

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

The essential components of Level 3 Triple P Primary Care include the following:

• Provide brief consultations (typically 3-4 contacts) in a one-to-one format
• Assist parents to develop parenting plans to manage behavioral issues (e.g., tantrums, fighting, going shopping) and skill development issues (e.g., eating independently, toilet training, staying in bed at night)
• Uses an explicit self-regulatory framework, including principles of:
• Self-sufficiency
• Self-efficacy
• Self-management
• Problem-solving
• Teaches parents how to monitor their own and their child's behavior, and asks them to set specific and observable goals for change
• Assists parents in applying the principles they have learned to solve problems in a self-sufficient manner that leads to more independence
• Encourages practitioners to use multiple, relevant examples with families and create a flexible teaching environment
• 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 3 Primary Care (Level 3 Triple P Primary) directly provides services to parents/caregivers and addresses the following:

• Behavioral, social, emotional, or developmental concerns for a child that are either anticipatory or mild to moderate in nature

Recommended Intensity

Typically delivered as 3-4 brief (15-30 minute) weekly sessions done in person, over the phone, or as a combination of both.

Recommended Duration

4-6 weeks

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Hospital
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Homework is an integral part of Level 3 Triple P Primary Care and is agreed upon in session and reviewed in each subsequent visit as the parent is supported in improved self-monitoring and self-regulation. Homework might include monitoring of parent behavior, implementation of positive parenting strategies and discipline routines, practice sessions with child, viewing videos, reviewing parent Tip Sheets, problem-solving exercises, and planned discussion with a parenting partner.

Languages

Triple P – Positive Parenting Program® – Level 3 Primary Care (Level 3 Triple P Primary) has materials available in the following languages other than English:

• Arabic
• Chinese
• Dutch
• Flemish
• French
• German
• Japanese
• Spanish
• Swedish

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

Resources Needed to Run Program

The typical resources for implementing the program are:

• Practitioner’s Kit for Primary Care Triple P (includes Practitioner’s Manual and Consultation Flip Chart)
• Triple P Tip Sheet Series – Sample Pack (includes Positive Parenting Booklet and a sample of Triple P Tip Sheets)
• Every Parent’s Survival Guide

Prerequisite/Minimum Provider Qualifications

The Level 3 Triple P Primary Care provider training courses are usually offered to practitioners with a post-high-school degree in health, education, childcare, 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.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual information:

• Turner, K. M. T., Sanders, M. R., & Markie-Dadds, C. (2010). Practitioner’s manual for Primary Care Triple P (2nd ed.). Triple P International Pty Ltd.

Manuals are provided to each participant enrolled in Primary Care Triple P training. Resource materials, including the manual, are provided during in-person training sessions, or are mailed out to a provided address for remotely delivered training. The manual is also able to be ordered via the Provider Site, which each practitioner has access to following completion of training.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Most commonly training is provided onsite with an agency or organization hosting the training. However, 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 Triple P website at www.triplep.net

Number of days/hours:

Training via open enrollment or agency: 5 days (2 days of intervention training + 1 day pre-accreditation workshop + 2 days of accreditation).

An extension course option is available for existing Triple P practitioners. Total time allocated for extension courses depends on what courses practitioners are already trained in:

• 1 day (1 training day and no accreditation day – quiz only)
• Previous training: Primary Care Teen or Primary Care Stepping Stones
• 2 days (1 training day and 1 accreditation day)
• Previous training: Group, Selected, Selected Stepping Stones, Discussion Group, Group Stepping Stones, or Standard Stepping Stones

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Triple P – Positive Parenting Program® – Level 3 Primary Care.

Formal Support for Implementation

There is no formal support available for implementation of Triple P – Positive Parenting Program® – Level 3 Primary Care.

Fidelity Measures

There are no fidelity measures for Triple P – Positive Parenting Program® – Level 3 Primary Care.

Established Psychometrics

There are no established psychometrics for Triple P – Positive Parenting Program® – Level 3 Primary Care.

Fidelity Measures Required

No fidelity measures are required for Triple P – Positive Parenting Program® – Level 3 Primary Care.

Implementation Guides or Manuals

There are no implementation guides or manuals for Triple P – Positive Parenting Program® – Level 3 Primary Care.

Implementation Cost

There are no studies of the costs of Triple P – Positive Parenting Program® – Level 3 Primary Care.

Research on How to Implement the Program

Research has not been conducted on how to implement Triple P – Positive Parenting Program® – Level 3 Primary Care.

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Turner, K. M. T., & Sanders, M. R. (2006). Help when it's needed first: A controlled evaluation of brief, preventive behavioral family intervention in a primary care setting. Behavior Therapy, 37(2), 131–142. https://doi.org/10.1016/j.beth.2005.05.004

  Type of Study: Randomized controlled trial

  Number of participants: 30 families

  Population:

  • Age — Children: Intervention: Mean=37.38 months; Waitlist Control: Mean=43.07 months; Parents: Mean=33–35 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status —

    Participants were parents of a child with behavioral problems or developmental issues.

  Location/Institution: Brisbane, Australia

  Summary:

  The purpose of the study was to evaluate the effectiveness of Primary Care Triple P [now called Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary)] one-on-one format with parents requesting help for child behavior problems. Participants were randomly assigned to the brief Primary Care Triple P intervention or a wait-list control condition. Measures utilized include the Family Background Questionnaire (FBQ), the Parent Daily Report (PDR), the Eyberg Child Behavior Inventory (ECBI), the Home and Community Problem Checklist (HCPC), the Parenting Scale (PS), the Family Observation Schedule (FOS), the Parenting Sense of Competence Scale (PSOC), the Depression, Anxiety, and Stress Scales (DASS), the Goal Achievement Scales (GAS), the Parenting Experience Survey (PES), and the Client Satisfaction Questionnaire (CSQ). Results indicate that parents who received Primary Care Triple P reported significantly lower rates of the targeted problem child behaviors than those in the wait-list condition on the PDR target behavior score and fewer problem settings at home (HCPC). There were also significantly fewer children in the intervention condition in the clinical range on the PDR following the intervention in comparison to children in the wait-list condition. Mothers receiving the intervention reported significantly less use of dysfunctional parenting practices (PS laxness, over-reactivity, and verbosity scales) than mothers in the wait-list condition. Intervention condition mothers reported a significantly greater level of satisfaction with their parenting role following the intervention in comparison to mothers who had not received the program. Results for the PSOC efficacy scale indicated a trend in the same direction for intervention condition mothers with them reporting significantly lower anxiety and stress than mothers in the wait-list condition. Intervention gains found at the postintervention assessment were primarily maintained at a 6-month follow-up of the intervention group. However, as there was no follow-up assessment of control families (since they had received Primary Care Triple P also at that point), it is not possible to conclude whether these measures of child behavior and parenting would vary from those of a control group at this assessment time. Limitations include potential reporting biases due to interpreting changes found on parent-report measures of child behavior and parenting, and a 6-month follow-up limited to the intervention group only.

  Length of controlled postintervention follow-up: None.

• de Graaf, I., Onrust, S., Haverman, M., & Janssens, J. (2009). Helping families improve: An evaluation of two primary care approaches to parenting support in the Netherlands. Infant and Child Development: An International Journal of Research and Practice, 18(6), 481–501. https://doi.org/10.1002/icd.634

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Number of participants: 129 parents

  Population:

  • Age — Children: Mean=6.2 years; Parents: Not specified
  • Race/Ethnicity — Not specified
  • Gender — 65% Male, Parents: 96% Female
  • Status —

    Participants were parents of children with mild to moderate behavioral and/or emotional problems.

  Location/Institution: The Netherlands

  Summary:

  The purpose of the study was to evaluate the most widely used Dutch practices for primary care parenting support and Primary Care Triple P [now called Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary)]. Participants were receiving either Dutch parenting consulting practices or Primary Care Triple P. Measures utilized include the Family Background Questionnaire (FBQ), Strengths and Difficulties Questionnaire (SDQ), Parenting Scale (PS), and the Being a Parent Scale (BPS). Results indicate that both interventions produced significant reductions in reported child emotional and behavior problems, that also remained after 3 months. For both groups, parenting styles were also found to have improved at both posttest and follow-up measurement. When compared with the regular Dutch parenting consultation practices, however, the Primary Care Triple P approach produced greater reductions in parental laxness and total parenting dysfunction, and greater improvement in total parenting competence at both posttest and follow-up. Limitations include lack of randomization of participants, self-reported measures, and length of follow-up.

  Length of controlled postintervention follow-up: 3 months.

• Schappin, R., Wijnroks, L., Uniken Venema, M., Wijnberg-Williams, B., Veenstra, R., Koopman-Esseboom, C., Mulder-De Tollenaer, S., van der Tweel, I., & Jongmans, M. (2013). Brief parenting intervention for parents of NICU graduates: A randomized, clinical trial of Primary Care Triple P. BMC Pediatrics, 13(1), 1–9. https://doi.org/10.1186/1471-2431-13-69

  Type of Study: Randomized controlled trial

  Number of participants: 67

  Population:

  • Age — Children: Control: Mean=43.6 months; Intervention: Mean=45.6 months; Mothers: Control: Mean=32.2 years; Intervention: Mean=34.1 years
  • Race/Ethnicity — Children: Not specified; Parents: Intervention: 97% European and 3% North-African (mothers only); Control: 100% European
  • Gender — Children: 60% Male; Parents: Not specified
  • Status —

    Participants were parents and their children born preterm or asphyxiated.

  Location/Institution: University Medical Center Utrecht/Wilhelmina Children's Hospital (Utrecht) and the Isala Clinics (Zwolle) – The Netherlands

  Summary:

  The purpose of the study was to evaluate the efficacy of the Primary Care Triple P [now called Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary)] one-on-one format in improving the quality of parent-child interaction and increasing the application of trained parenting skills in parents of preterm-born or asphyxiated term-born preschoolers with behavioral problems. Participants were children who were randomly assigned to Primary Care Triple P or a wait-list control group. Measures utilized include the Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Eyberg Child Behavior Inventory (ECBI), and the Client Satisfaction Questionnaire (CSQ). Results indicate that Primary Care Triple P is not effective in improving the quality of parent-child interaction nor does it increase the application of trained parenting skills in parents of preterm-born or asphyxiated term-born children with behavioral problems. There was no significant difference in favor of Primary Care Triple P between the intervention group and the control group at the 6-month trial endpoint. At the 12-month follow-up, most measures showed no changes in parenting behavior. However, when changes were present, TRF presented more problems for the Primary Care Triple P group, whilst they increased or remained stable in the control group. Limitations include that the intervention showed no effect on outcomes, reliance on self-reported measures, small sample size, and lack of generalizability due to ethnicity.

  Length of controlled postintervention follow-up: 12 months.

• Spijkers, W., Jansen, D. E., & Reijneveld, S. A. (2013). Effectiveness of Primary Care Triple P on child psychosocial problems in preventive child healthcare: A randomized controlled trial. BMC Medicine, 11(1), 1–8. https://doi.org/10.1186/1741-7015-11-240

  Type of Study: Randomized controlled trial

  Number of participants: 81 families

  Population:

  • Age — Children: 9–11 years; Parents: Usual Care: Mean=40.94 years; Primary Care: Mean=44.06 years
  • Race/Ethnicity — Children: Not specified; Parents: 96% Dutch
  • Gender — Children: 56% Male; Parents: Not specified
  • Status —

    Participants were parents of children with mild psychosocial problems.

  Location/Institution: The Netherlands

  Summary:

  The purpose of the study was to assess the effectiveness of the Primary Care Triple P (PCTP) program [now called Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary)] one-on-one format compared with care as usual (UC) for parents of children with mild psychosocial problems. Participants were randomly assigned to PCTP or UC. Measures utilized include the Strengths and Difficulties Questionnaire (SDQ), Parenting Scale (PS), Problem Setting and Behaviour Checklist (PSBC), the Parenting Stress Index (PSI), the Depression Anxiety Stress Scale (DASS), and the Eyberg Child Behaviour Inventory (ECBI). Results indicate that at 6- and 12-month follow-ups there were no statistically significant differences between parents in the PCTP and UC groups on either the primary or secondary outcome measures, but those in the PCTP group yielded slightly better results than UC on most of these outcomes. Only in one SDQ field, namely, conduct problems, was a statistically significant difference detected, which was in favor of the PCTP condition. In general, a decrease in child psychosocial problems and parenting stress was found for both PCTP and UC. Limitations include the small sample size, and reliance on self-reported measures.

  Length of controlled postintervention follow-up: 6 and 12 months.

• McCormick, E., Kerns, S. E. U., McPhillips, H., Wright, J., Christakis, D. A., & Rivara, F. P. (2014). Training pediatric residents to provide parent education: A randomized controlled trial. Academic Pediatrics, 14(4), 353–360. https://doi.org/10.1016/j.acap.2014.03.009

  Type of Study: Randomized controlled trial

  Number of participants: 154 (53 Residents; 101 Parents)

  Population:

  • Age — Children: Mean=4.8 years; Parents: Not specified; Residents: Not specified
  • Race/Ethnicity — Children: Not specified; Parents: 38% Other, 34% White, and 27% African American/Black; Residents: Not specified
  • Gender — Children: 48% Female; Parents: 80% Female; Residents: 79% Female
  • Status —

    Participants were pediatric residents and the parents of the children to whom the pediatric resident provided care.

  Location/Institution: Three community clinics operated by the University of Washington

  Summary:

  The purpose of the study was to examine the efficacy of the Primary Care Triple P (PC Triple P) intervention [now called Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary)] one-on-one format on pediatric residents’ skills and confidence in delivering parenting information, and to understand the potential impact of residents’ PC Triple P training status on parents’ sense of self-efficacy in parenting and discipline strategies as well as child behavior. Participants were residents who consented to participate and were randomized into one of two conditions: 1) intervention, which involved immediate training in PC Triple P, or 2) wait-list control, which involved the usual provision of well-child services until subsequent training in PC Triple P. Residents trained in PC Triple P then provided PC Triple P to parents of their patients as appropriate. Measures utilized include Child Behavior Checklist (CBCL), Parent Consultation Skills Checklist (PCSC), Parenting Sense of Competence Scale (PSOC), and the International Society for the Prevention of Child Abuse and Neglect’s Child Abuse Screening Tool–Parent Version (ICAST-P). Results indicate that at postintervention, compared to the waitlist control group, the impact of intervention-trained residents on parents' sense of self-efficacy, discipline strategies, and child behavior was mixed, with the greatest group effect occurring on parent-reported discipline strategies, especially among parents who reported the most problems at baseline. Parents exposed to PC Triple P trained residents demonstrated a higher rate of positive discipline strategies at follow-up. However, there appeared to be little impact of the intervention on the other parent measures. No differences were found for child behavior or parenting sense of confidence. Compared to the control group, intervention gains were maintained for residents at 9-month follow-up. Limitations include the small sample size, reliance on self-reported measures, and recruitment and implementation level barriers.

  Length of controlled postintervention follow-up: 9 months.

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