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

About This Program

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

For parents/caregivers of children ages: 0 – 12

Program Overview

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.

Program Goals

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

Essential Components

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)

Program Delivery

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
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Parents and caregivers are encouraged to share their parenting plans with other caregivers, family members and/or additional supports as relevant/helpful. In addition, other caretakers or family members may also participate in the direct service delivery when relevant and agreed upon by the family.

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

Homework

Triple P - Positive Parenting Program® - Level 3 Primary Care (Level 3 Triple P Primary) includes a homework component:

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 languages other than English:

Chinese, French, German, Japanese, Spanish, Swedish

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:

  • The accompanying parent resources (might include use of a Tip Sheet and/or Triple P Flip Chart)
  • A space to talk with the parent that is comfortable for the parent (e.g., appropriate level of privacy, etc.)
  • Equipment to show families DVD clips (e.g., laptop with a DVD, portable DVD player, TV with DVD, etc.)

Education and Training

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.

Education and Training Resources

There is a manual that describes how to deliver 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, 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 for Level 3 Triple P Primary Care is offered as a stand-alone course consisting of 2 full training days. Following the initial training practitioners then complete 1 full-day of Pre-Accreditation 4-6 weeks following training, and a 1/2 day accreditation (per trainee) held 6-8 weeks post-training. Training and Pre-Accreditation cohorts are comprised of 20 trainees with one Triple P trainer. 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.

Relevant Published, Peer-Reviewed Research

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: Mean=37.38 in the intervention condition and 43.07 months in the waitlist control (approx. 3.12–3.59 years), Parental mean = 33–35 years
  • Race/Ethnicity — Children: Not specified, Parents: Not specified
  • Gender — Children: Not specified, Parents: Not specified
  • Status — Participants were parents of child with behavioral problems or developmental issues.

Location/Institution: Brisbane, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study aimed to evaluate the effectiveness of Primary Care Triple P [now called Triple P Level 3 Primary Care] one-on-one format with parents requesting help for child behavior problems. Families 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), Home and Community Problem Checklist (HCPC), Parenting Scale (PS), 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 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. The result 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 follow-up limited to intervention group only.

Length of postintervention follow-up: 6 months (intervention group only).

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
Number of Participants: 129 parents

Population:

  • Age — Children: Mean=6.2 years, Parents: Not specified
  • Race/Ethnicity — Children: Not specified; Parents: Not specified
  • Gender — Children: 65% Male, Parents: 95%
  • Status — Participants were parents of children with mild to moderate behavioral and/or emotional problems.

Location/Institution: The Netherlands

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the most widely used Dutch practices for primary care parenting support and Primary Care Triple P [now called Triple P Level 3 Primary Care]. Measures utilized include the Family Background Questionnaire (FBQ), Strengths and Difficulties Questionnaire (SDQ), Parenting Scale (PS), and the Being a Parent Scale (BPS). Results indicated 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 postintervention follow-up: 3 months.

Boyle, C. L., Sanders, M. R., Lutzker, J. R., Prinz, R. J., Shapiro, C., & Whitaker, D. J. (2010). An analysis of training, generalization, and maintenance effects of primary care Triple P for parents of preschool-aged children with disruptive behavior. Child Psychiatry & Human Development, 41(1), 114–131. https://doi.org/10.1007/s10578-009-0156-7

Type of Study: One-group pretest–posttest
Number of Participants: 9 families (10 children)

Population:

  • Age — Children: 3-7 years, Parents: Not specified
  • Race/Ethnicity — Children: Not specified; Parents: Not specified
  • Gender — Children: 6 Females and 4 Males, Parents: Not specified
  • Status — Participants were parents recruited from local pediatricians, print media, flyers, and word of mouth.

Location/Institution: Two southern US cities

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of Primary Care Triple P (PC Triple P) intervention [now called Triple P Level 3 Primary Care]. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), Parenting Experience Survey (PES), the Client Satisfaction Questionnaire (CSQ), the Family Background Questionnaire (FBQ), Parenting Tasks Checklist (PTC; including the Behavioral and Setting Self-Efficacy measures) and the Revised Family Observation Schedule (FOS-R-III) using Video Taped Family Observations. Results indicated that independent observations of parent-child interaction in the home revealed that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent report data also confirmed there were significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the PES, and high levels of consumer satisfaction. All short-term intervention effects were maintained at four-month follow-up. Limitations include small sample size, need for more diverse population of parents with a greater representation of minority and low-income families, and length of follow-up.

Length of postintervention follow-up: 4 months.

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

Type of Study: Randomized controlled trial
Number of Participants: 67

Population:

  • Age — Children: Mean=43.6 months (Control) – 45.6 months (Intervention), Mothers: Mean=32.2 years (Control) – 34.1 years (Intervention)
  • Race/Ethnicity — Children: Not specified, Parents: 97% European and 3% North-African (mothers only) for Intervention, 100% European for Control
  • Gender — Children: 60% Males; 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: (To include comparison groups, outcomes, measures, notable limitations)
This study aimed to evaluate the efficacy of the Primary Care Triple P [now called Triple P Level 3 Primary Care] 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. Children 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 showed 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 intervention showed no effect on outcomes, reliance on self-reported measures, small sample size, and generalizability due to ethnicity.

Length of 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, 240. 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: Mean=40.94 years in usual care and 44.06 years in Primary Care
  • Race/Ethnicity — Children: Not specified, Parents: 96% Dutch
  • Gender — Children: 55.7% Male, Parents: Not specified
  • Status — Participants were parents of children with mild psychosocial problems.

Location/Institution: The Netherlands

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The objective of this study was to assess the effectiveness of the Primary Care Triple P (PCTP) program [now called Triple P Level 3 Primary Care] one-on-one format compared with care as usual (UC) for parents of children with mild psychosocial problems. Participants were randomly assigned to Primary Care Triple P or usual care (UC). Measures utilized include the Strengths and Difficulties Questionnaire (SDQ), Parenting Scale (PS), Problem Setting and Behavior Checklist (PSBC), the Parenting Stress Index (PSI), the Depression Anxiety Stress Scale (DASS) and the Eyberg Child Behavior Inventory (ECBI). Results showed at 6- and 12-month follow-up 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 small sample size and reliance on self-reported measures.

Length of 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 (resident participation = 53; parent participation = 101)

Population:

  • Age — Children: Mean=4.8 years, Parents: Not specified, Residents: Not specified
  • Race/Ethnicity — Children: Not specified; Parents: 34% White, 27% African American/black, and 38% Other; Residents: Not specified
  • Gender — Children: 47.5% 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: 3 community clinics operated by the University of Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of the Primary Care Triple P (PC Triple P) intervention [now called Triple P Level 3 Primary Care] one-on-one format on pediatric residents’ skill and confidence in delivering parenting information; and to understand the potential impact of residents’ Triple P training status on parents’ sense of self-efficacy in parenting and discipline strategies as well as child behavior. Residents who consented to participation were randomized into one of two conditions: 1) intervention, which involved immediate training in Primary Care Triple P (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 showed that at postintervention compared to the waitlist control group, the impact of intervention-trained residents on parent’s 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 small sample size, self-reported measures, and recruitment and implementation level barriers.

Length of postintervention follow-up: 9 months.

Additional References

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

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: October 2019

Date Program Content Last Reviewed by Program Staff: January 2020

Date Program Originally Loaded onto CEBC: January 2020