Triple P - Positive Parenting Program® System (System Triple P)
About This Program
Target Population: For parents and caregivers of children from birth to age 16
The overall Triple P program is a multi-tiered system of 5 levels of education and support for parents and caregivers of children and adolescents. Although Triple P can be used in parts (e.g., using only one level of the five or a group version versus standard), this entry on the CEBC reviews System Triple P as a whole (i.e., using all 5 levels) in its standard version and only reviewed research evidence that evaluated the whole system. The CEBC also evaluated Triple P Level 4 as a separate program and it is rated a "1 - Well-Supported Research Evidence" on the Scientific Rating Scale in the areas of Parent Training Programs That Address Behavior Problems in Children and Adolescents and Disruptive Behavior Treatment (Child & Adolescent).
As a prevention program, System Triple P helps parents learn strategies that promote social competence and self-regulation in children. Parents become better equipped to handle the stress of everyday child rearing and children become better able to respond positively to their individual developmental challenges. As an early intervention, System Triple P can assist families in greater distress by working with parents of children who are experiencing moderate to severe behavior problems. Throughout the program, parents are encouraged to develop a parenting plan that makes use of a variety of System Triple P strategies and tools. System Triple P practitioners are trained, therefore, to work with parents’ strengths and to provide a supportive, non-judgmental environment where a parent can continually improve their parenting skills.
The goals of Triple P - Positive Parenting Program® System (System Triple P) 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 the Triple P - Positive Parenting Program® System (System Triple P) include:
- Uses practitioners who are trained to create a supportive learning environment for parents to receive and discuss practical information about parenting skills that they can incorporate into everyday interactions with their children
- Uses a multi-level system of interventions:
- Level 1 is a comprehensive media campaign and distribution strategy for delivering positive parenting information to all families within a given community.
- Level 2 interventions are delivered to parents through low-intensity seminars or single-session meetings.
- Level 3 interventions are brief in duration (1-4 sessions) and focus on identifying and resolving commonly encountered behavior problems in childhood. Level 3 interventions may be offered in a variety of settings where parents naturally visit.
- Level 4 interventions are delivered in 8-10 sessions and offer parents a more comprehensive set of strategies for improving family functioning and parent-child relationships in any situation. The interventions have sufficient impact to address moderate to severe behavior problems in children.
- Level 5 interventions offer further support for parents with specific risk factors (e.g., families at high risk for child maltreatment, families going through a divorce or separation, or families with overweight or obese children) or for parents with continuing needs following a Level 4 intervention.
- Uses developmentally appropriate interventions with a variety of media:
- System Triple P provides a program designed for infants, toddlers, preschoolers and elementary school-aged children, as well as a distinct program for early teens.
- In each distinct developmental stage (i.e., infants, toddlers, preschoolers, primary school children, early teens, and teens), Triple P provides single behavior tip sheets for common behaviors that parents ask about.
- System Triple P interventions are delivered with a variety of resources used in session and later in assigned homework to impart information and to provide a parent with practice exercises when at home. In Levels 2-3, parents will receive specific “tipsheets” to try out. In Levels 4 - 5, parents work through a workbook with more involved practice exercises.
- System Triple P uses implementation resources that include the following:
- Level 1 uses a Parent Tippaper, brochures, posters, newspaper columns, radio/TV/text messages, and parent, practitioner, and agency websites.
- Level 2 uses parent tipsheets, practitioner group presentations, and a DVD for parent viewing.
- Level 3 uses parent tipsheets, parent discussion booklets, a DVD for parent viewing, and a practitioner flip chart.
- Level 4 uses parent workbooks, parent DVD collections, practitioner presentations, a self-directed workbook, and an online application.
- Level 5 uses parent workbooks, parent DVD collections, and practitioner presentations.
- Uses an explicit self-regulatory framework:
- Framework includes principles of self-sufficiency, self-efficacy, self-management, and problem-solving.
- Parents are 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 are enhanced by having the practitioner prompt the parents to review their 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.
- Parents are assisted in applying the principles they have learned to solve problems in a self-sufficient manner that leads to more independence.
- Practitioners are 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:
- System Triple P allows tailoring of intervention intensity to meet individual family needs which helps cost effectiveness.
- Practitioners assess the level of risk the family faces via an intake interview, questionnaires, monitoring, and observation of parent-child interaction.
- Practitioners tailor 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).
- Practitioners administer assessments after completion of an intervention level to determine if a family needs additional levels of intervention.
- Incorporates identifiable program elements to promote generalization and transfer of learning:
- System Triple P provides multiple examples as part of its flexible training philosophy.
- System Triple P teaches generalization and maintenance across time, situations, and children.
- Practitioners teach parents strategies for managing high-risk situations (e.g., going shopping) to ensure generalization across contexts.
- Offers and evaluates flexible delivery modalities such as:
- Media-based delivery (e.g., television series, radio public service messaging, and newsletters) - Level 1
- Group delivery (large and small groups; single meeting group for one behavior or multiple meeting group for broad-based skill development)
- Selected Seminars - Level 2: Seminars can accommodate a small to large number of parents (10 – hundreds).
- Discussion Group - Level 3: Discussion groups can accommodate, on average, 10 parents.
- Targeted Behavior Interventions - Levels 4 and 5: Groups of families (up to 12 parents) or individual families.
- Individual delivery – Levels 4 and 5 primarily
- Levels 2-5 may be offered in a variety of settings (e.g., home, clinic, school, family resource center)
Triple P - Positive Parenting Program® System (System Triple P) directly provides services to parents/caregivers and addresses the following:
- Management of child behavior problems, management of 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 System 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.
Level 1 - Universal/Stay Positive which has variable outreach strategies (websites, parent newspaper, brochures, posters, and radio/TV spots) that are planned to reach the entire population at planned intervals. ----- Level 2 - Selected Seminars/Selected Seminars Teen which has 3 two-hour long seminars that may be offered as standalone events or together in a series and brief primary care which has 1-2 brief consultations up to 30 minutes in duration. ----- Level 3 - Primary Care/Primary Care Teen/Primary Care Stepping Stones which has 1-4 brief consultations that are approximately 30 minutes in duration and 4 two-hour long discussion groups that may be offered as standalone events or together in a series. ----- Level 4 - This level can consist of a variety of options: 1) Group/Group Teen/Group Stepping Stones which has 5 two-hour group sessions and 3 twenty-minute individual telephone consultations for each family offered over 8 consecutive weeks; 2) Triple P Online which has 8 self-paced online modules; A self-directed workbook which is self-paced; or 4) Standard/Standard Teen/Standard Stepping Stones which are 10 one-hour sessions that occur weekly. ----- Level 5 - This level can consist of a variety of options: 1) Enhanced which has 3-10 sessions lasting 60-90 minutes each; 2) Pathways which has 4 sessions lasting 60-90 minutes each when offered individually or two hours each when offered as a group; 3) Family Transitions which has 10 two-hour group sessions with 2 individual telephone consultations for each family lasting 30 minutes; or 4) Group Lifestyle which has 10 90-minute groups with 4 individual telephone consultations for each family lasting 30 minutes.
Level 1 Universal Triple P may be planned for intermittent distribution of materials throughout the course of the Level 2-5 interventions. Stay Positive is typically planned as a three-year implementation. ----- Levels 2-3 interventions may include 1-4 encounters that take place over 1-6 weeks. ----- Level 4-5 interventions typically take place over 4-5 months. If accommodations are needed (e.g., low literacy clients), the duration may be longer.
This program is typically conducted in a(n):
- Adoptive Home
- Birth Family Home
- Foster / Kinship Care
- Outpatient Clinic
- Community-based Agency / Organization / Provider
- Group or Residential Care
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Triple P - Positive Parenting Program® System (System Triple P) includes a homework component:
Homework is an integral part of System 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.
Triple P - Positive Parenting Program® System (System Triple P) has materials available in languages other than English:
Arabic, Berber, Chinese, French, Greek, Japanese, Malay, Portuguese, Romanian, 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 presentation as well as show DVD clips to parents. Practitioners will also need a white board or flip chart. Level 2-5 interventions require a single practitioner/consultant to provide the direct service. However, it is highly recommended that agencies staff their System Triple P program in order to sustain it. For even the smallest implementations, 4 practitioners are recommended.
Education and Training
Prerequisite/Minimum Provider Qualifications
System 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 deliver this program, and there is training available for this program.
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.
Number of days/hours:
Depending on the specific training(s), the number of days can be between 2-5 days, plus 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.
There are pre-implementation materials to measure organizational or provider readiness for Triple P - Positive Parenting Program® System (System 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
- Supervisor/Manager Readiness Form
- Practitioner Selection/Fit Form
- Community Assessment/Implementation Milestones Checklist
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 firstname.lastname@example.org 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® System (System Triple P) as listed below:
Triple P America utilizes the Triple P Implementation Framework. The Framework is flexible and follows the key principles of Triple P – self-regulation and minimal sufficiency (i.e., it is a guiding framework for support of those implementing Triple P and the level of support may be decreased or increased to match the needs and available resources for a given agency or community.) For this reason, the Framework supports the full range of potential implementation possibilities from small, single organization implementations to complex multi-sector public health applications.
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.
There are fidelity measures for Triple P - Positive Parenting Program® System (System Triple P) as listed below:
Triple P has three quality assurance/fidelity checks built into its implementation framework:
- 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.
- 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.
- 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 email@example.com for further information on measures of fidelity.
Implementation Guides or Manuals
There are implementation guides or manuals for Triple P - Positive Parenting Program® System (System 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 firstname.lastname@example.org 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® System (System 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.
- Sanders, M. and K. Burke (2014). The “hidden” technology of effective parent consultation: A guided participation model for promoting change in families. Journal of Child and Family Studies, 23(7), 1289-1297. doi: 10.1007/s10826-013-9827-x
- 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.
Turner, K. M. T., Nicholson, J. M., & Sanders, M. R. (2011). The role of practitioner self-efficacy, training, program and workplace factors on the implementation of an evidence-based parenting intervention in primary care. Journal of Primary Prevention, 32(2), 95-112. doi: 10.1007/s10935-011-0240-1.
Relevant Published, Peer-Reviewed Research
*Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P System population trial. Prevention Science, 10, 1-12.
Type of Study:
Randomized controlled trial
Number of Participants: Approximately 85,000
- Age — Birth-8 years
- Race/Ethnicity — 31% African American and 59% Not specified
- Gender — Not specified
- Status — Participants were service providers and families with children under 8 years old with substantiated child maltreatment cases.
Location/Institution: Southeastern U.S.
(To include comparison groups, outcomes, measures, notable limitations)
Eighteen counties of approximately 50,000 to 175,000 residents were randomly assigned to receive implementations of System Triple P or to services as usual. In treatment counties, 649 service providers were trained after randomization. Substantiated child maltreatment (CM), out-of-home placement, and hospitalization of emergency room visits for CM-related injuries served as pre-and post-treatment outcome measures. Prior to treatment the two groups did not differ on the three measures. Data from the 12 months following the end of the intervention showed that those counties receiving System Triple P had significantly lower levels of rates of substantiated CM, child out-of-home placements, and hospitalizations or emergency-room visits for CM injuries than the control counties. Limitations include underestimate the true prevalence of harmful parenting practices, population trial rather than a more traditional clinical trial, and possibility of spillover effects from intervention to control counties.
Length of postintervention follow-up: 1 year.
Mihalopoulos, C., Sanders, M. R., Turner, K. M., Murphy-Brennan, M., & Carter, R. (2007). Does the Triple P-Positive Parenting Program provide value for money?. Australasian Psychiatry, 41(3), 239-246.
Type of Study:
Cost study - threshold analysis with limited cost-effectiveness analysis
Number of Participants: 12,582
- Age — 6-12 years
- Race/Ethnicity — Not Specified
- Gender — Not Specified
- Status — Participants were parents of children age 6 to 12 years old with conduct disorder.
Location/Institution: Queensland, Australia
(To include comparison groups, outcomes, measures, notable limitations)
The aim of the present study was to investigate the economic case for the implementation of the Triple P - Positive Parenting Program (System Triple P) on a population in order to reduce the prevalence of conduct disorder in children. Results concluded that System Triple P has the potential of saving more resources than it consumes. Limitations include that cost-offsets modeled do not necessarily represent actual financial savings and it is not possible to compare the results of the current study with other economic evaluations of preventative or early-targeted parenting interventions as none have been published.
Length of postintervention follow-up: None
Sanders, M. R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S., & Bidwell, K. (2008). Every family: A population approach to reducing behavioral and emotional problems in children making the transition to school. Journal of Primary Prevention, 29, 197-222.
Type of Study:
Nonrandomized controlled trial
Number of Participants: 3,000
- Age — 4-7 years
- Race/Ethnicity — Not Specified
- Gender — Not Specified
- Status — Participants were parents of children age 4 to 7 years.
Location/Institution: Brisbane, Sydney & Melbourne Australia
(To include comparison groups, outcomes, measures, notable limitations)
This study evaluated reports the effects of System Triple P and care as usual (CAU). Measures include utilization of household survey interviews that were conducted using a computer-assisted telephone interviewing (CATI) system and the Strengths and Difficulties Questionnaire (SDQ). All five levels of the System Triple P multilevel system of intervention were employed; including a local mass media strategy, a primary care strategy, and three more intensive levels of parenting intervention delivered by a range of service providers (e.g., health, education, and welfare sectors). At post-intervention, there were significantly greater reductions in the System Triple P communities in the number of children with clinically elevated and borderline behavioral and emotional problems compared to the CAU communities. Similarly, parents reported a greater reduction in the prevalence of depression, stress, and coercive parenting. Limitations include nonrandomization and possible reporter bias.
Length of postintervention follow-up: 2 years.
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. (2012a). 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
Date Research Evidence Last Reviewed by CEBC: July 2019
Date Program Content Last Reviewed by Program Staff: March 2015
Date Program Originally Loaded onto CEBC: June 2006