Triple P-Positive Parenting Program - Detailed Report

Uses developmentally appropriate interventions

• Provides a program designed for preschoolers and primary school children, as well as a distinct program for early teens.
• Provides tip sheets for each distinct age group (infants, toddlers, preschoolers, primary school children, early teens, and teens).

Uses an explicit self-regulatory framework

• Includes principles of: Self-sufficiency, Self-efficacy, Self-management, and Problem-solving.
• Teaches parents how to monitor behavior and asks them to set specific and observable goals.
• Enhances self-management and self-sufficiency by the practitioner prompting the parent to review their implementation of parenting strategies. Asks parent to reflect on what they did well in the process (their strengths) and to set specific goals for any weaknesses they observed.
• Assists parents in applying the principles they have learned to solve problems in a self-sufficient manner by using multiple examples and a flexible teaching environment.

Uses the principles of 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, observation by practitioner.
• Tailors the level of intensity based on the level of risk the family faces (i.e., the higher the risk, the higher the intensity).
• Administers assessments after completion of an intervention level to determine if a family needs additional levels of intervention.

Incorporates identifiable program elements to promote generalization or 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
• Self-directed program delivery with or without telephone support
• Media-based delivery (e.g., television series)

Sander, 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 families
Population:

Age Range: 3 years
Race/Ethnicity: Caucasian
Status (e.g., foster care, CW): Volunteer families demonstrating at least one risk factor.

Location/Institution: Australia
Summary: Families were recruited through a community outreach campaign. 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 Triple P, enhanced Triple P, self-directed Triple P, or a wait list. Standard Triple P employs the same materials as the self-directed program, but adds 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. At post-test, the two practitioner-assisted interventions were associated with lower levels of parent-reported disruptive child behavior (measured by the Parent Daily Report and the Eyberg Child Behavior Inventory), lower levels of dysfunctional parenting (measured in observation by the Family Observation Schedule (FOS-R-III) and by the Parenting Scale), and sense of competence (measured by the Parenting Sense of Competence Scale. 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. However, 1-year outcomes were compared to pretest levels only, not to the wait-list controls.
Length of post-intervention follow-up: 1 year

Leung, C., Sanders, M.R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.

Type of Study: Randomized Controlled Trial
Number of participants: 69 parents
Population:

Age Range: Children 3 to 7 years old
Race/Ethnicity: Asian
Status (e.g., foster care, CW): Attending Maternal and Child Health Centers or Child Assessment Centers (referred for developmental problems.)

Location/Institution: Hong Kong
Summary: Families were randomly assigned to Triple P or a wait-list control group. Measures were completed pre-treatment and immediately post-treatment. Child behaviors were assessed with the Parent Daily Report, the Eyberg Child Behavior Inventory, and the Strengths and Difficulties Scale, which assesses parents’ perceptions of prosocial and difficult behaviors in children. Parenting was assessed with the Parenting Scale, and the Parenting Sense of Competence Scale. Relationship with the parents’ partner was assessed with the Parent Problem Checklist and the Relationship Quality Index. Post-intervention scores indicated lower levels of child behavior problems, lower dysfunctional parenting styles and a higher sense of competence for the Triple P group in comparison with controls. Limitations of the study include a small number of participants and reliance on self-report data only.
Length of post-intervention follow-up: None

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 Range: 3 years
Race/Ethnicity: Caucasian
Status (e.g., foster care, CW): Volunteer families demonstrating at least one risk factor

Location/Institution: Australia
Summary: A subset of children from the same sample as Sanders, Markie-Dadds & Bor, (2000) was drawn based on demonstration of ADHD criteria obtained in a clinical interview with mothers. Participants were randomly assigned to one of three conditions, Enhanced Triple P, Standard Triple P, or a waitlist control. Before and after treatment, child behavior was assessed using the Revised Family Observation Schedule (FOS-RIII). Parents were assessed with the Beck Depression Inventory and the Child Abuse Potential Inventory. Their perceptions of disruptive behavior and other problems were measured with the Eyberg Child Behavior Inventory and the Parent Daily Report. Attitudes and style of parenting were measured with the Parenting Scale, the Parenting Sense of Competency Scale, and the Parent Problem Checklist, which assesses conflicts between parents. At post-intervention, 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 one-year follow-up.
Length of post-intervention follow-up: 1 year

Martin, A.J., & Sanders, M.R. (2003). Balancing work and family: A controlled evaluation of the Triple-P Positive Parenting Program as a work-site intervention. Child and Adolescent Mental Health, 8(4), 161-169.

Type of Study: Randomized Controlled Trial
Number of participants: 42 families
Population:

Age Range: 3 to 9 years.
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Staff of University of Queensland

Location/Institution: University of Queensland, Australia
Summary: Participants were recruited from the academic and general staff of the University. To be included, they were required to have a child with behavioral problems in the clinical range on the difficulties scales on the Strengths and Difficulties Questionnaire. Participants were randomly assigned to either a group version of the Triple P program or a waitlist control. Parent-reported child behavior was measure pre-treatment and at follow-up on the Strengths and Difficulties Questionnaire, and the Eyberg Child Behavior Inventory. Parenting was assessed by the Parenting Scale, the Problem Setting and Behavior Checklist, which measures parental self-efficacy. Researchers also administered the Depression-Anxiety Stress Scale, the Social Support Scale, the Work and Life Attitudes Survey and the Work Commitment Questionnaire. At the end of the interventions, parents reported lower levels of disruptive child behavior and dysfunctional parenting practices and higher levels of self-efficacy in managing home and work responsibilities. These improvements were maintained at the 4-month follow-up.
Length of post-intervention follow-up: 4 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 non-matched comparison group
Number of participants: 1610
Population:

Age Range: 3 to 4 years
Race/Ethnicity: None given
Status (e.g., foster care, CW): Volunteers

Location/Institution: Eastern (Intervention) and Southern (Comparison) Metropolitan Health Region of Western Australia.
Summary: Participants were recruited through media and professional referral. 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. Child behavior was assessed with the Eyberg Child Behavior Inventory. Parenting was measured with the Parenting Scale, and the Parent Problem Checklist. Researchers also measured relationship satisfaction in couples with the Abbreviated Dyadic Adjustment Scale, and parents’ well-being with the Depression, Anxiety Stress Scales. Tests were re-administered at 12 and 24 months following treatment. Treatment was associated with 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 include 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 higher education. However, comparison group children entered the study with lower average levels of behavior problems.
Length of post-intervention follow-up: 2 years,

Roberts, C., Mazzucchelli, T., Studman, L., & Sanders, M. (2006). Behavioral family intervention for children with developmental disabilities and behavioral problems. Journal of Clinical Child and Adolescent Psychology, 35(2), 180-193.

Type of Study: Randomized Controlled Trial
Number of participants: 47 families
Population:

Age Range: 2 to 7 years
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Registered with Western Australian Disability Services Commission

Location/Institution: Australia
Summary: Participant children had levels intellectual or adaptive functions below age norms, due to genetic causes, cerebral palsy, accident, disease, or unknown causes. Families were receiving services including speech and occupational therapy, physiotherapy and pre-educational skills. Children’s level of functioning was assessed with the Stanford Binet Intelligence Scale (4th edition) and the Vineland Adaptive Behavior Scales, which measures personal and social skills. Families were randomly assigned to the intervention group or a wait list. Intervention participants received instruction in the Stepping Stones Triple P program, which was adapted for use with parents of children with developmental disabilities. Family interactions were coded on the Family Observation Schedule-Revised III, by coders who were unaware of their group assignment. Mothers and fathers impressions of child behavior were assessed using the Developmental Behavior Checklist (Parent Version). Parenting was also measured on the Parenting Scale and parental depression was measured on the Depression Anxiety Stress Scale. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. These effects were maintained at the 6-month follow-up. One limitation of the study was attrition: 29 families participated at post-intervention and 15 intervention children remained at 6 months.
Length of post-intervention follow-up: 6 months.

Turner, K.M.T., Richards, M., & Sanders, M.R. (2007). Randomized clinical trial of a group parent education programme for Australian indigenous families. Journal of Paediatrics and Child Health, 43, 429-437.

Type of Study: Randomized controlled trial.
Number of participants: 51 families
Population:

Age Range: 1 to 13 years
Race/Ethnicity: Indigenous Australian
Status (e.g., foster care, CW): Families requesting help for child behavioral or development issues at community health sites.

Location/Institution: Australia
Summary: Families were recruited if they had a preadolescent child, the primary caregiver had concerns about the child’s behavior and their own parenting skills. Children were excluded if they had developmental delays, major disabilities, were autistic, or were currently on medication or receiving other treatment for behavior problems. Participants were randomly assigned to the intervention group or a wait list. The intervention was a culturally sensitive adaptation of the Triple P group program. Child behavior was measured with the Eyberg Child Behavior Inventory and the Strengths and Difficulties Questionnaire. Parenting and parental adjustment were measure with the Parenting Scale, the Parenting Experiences Scale and the Depression Anxiety Stress Scale. Parents attending group Triple P reported a decrease in rates of problem child behavior and less reliance on some dysfunctional verbal parenting practices such as overly long reprimands and talking rather than taking action. No difference was seen on parental over-reactivity (e.g., authoritarian discipline, displays of anger) or permissiveness. Effects were primarily maintained over 6 months.
Length of post-intervention follow-up: 6 months.

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, 571-587.

Hoath, F. E., & Sanders, M. R. (2002). A feasibility study of enhanced Group Triple P - Positive Parenting Program for parents of children with attention-deficit/hyperactivity disorder. Behaviour Change, 19(4), 191-206.

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(2), 127-142.

Leung, C., Sanders, M. R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.

Martin, A. J., & Sanders, M. R. (2003). Balancing work and family: A controlled evaluation of the Triple P-Positive Parenting Program as a work-site intervention. Child & Adolescent Mental Health, 8(4), 161-169.

Mihalpolous, C., Sanders, M. R., Turner, K. M. T., Murphy-Brennan, M., & Carter, R. (2007). Does the Triple P-Positive Parenting Program provide value for money? Australian and New Zealand Journal of Psychiatry, 41(3), 239 - 246.

Plant, K. M., & Sanders, M. R. (2007). Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities. Research in Developmental Disabilities, 28, 362-385.

Roberts, C., Mazzucchelli, T., Studman, L., & Sanders, M. R. (2006). Behavioral Family Intervention for Children With Developmental Disabilities and Behavioral Problems. Journal of Clinical Child and Adolescent Psychology, 35, 180-193.

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

Sanders, M. R., Pidgeon, A. M., Gravestock, F., Connors, M. D., Brown, S., & Young, R. W. (2004). Does parental attributional retraining and anger management enhance the effects of the Triple P-Positive Parenting Program with parents at risk of child maltreatment? Behavior Therapy, 35(3), 513-535.

Sanders, M. R., Ralph, A., Thompson, R., Sofronoff, K., Gardiner, P., Bidwell, K., & Dwyer, S. (2005). Every Family: A public health approach to promoting children’s wellbeing, Brisbane, Australia: The University of Queensland.

Turner, K. M. T., Richards, M., & Sanders, M. R. (2007). Randomised clinical trial of a group parent education programme for Australian indigenous families. Journal of Paediatrics and Child Health, 43, 429-437.

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