A multi-tiered system of education and support for parents and caregivers of children up to age 16, to address child behavioural and emotional problems and build strong families.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Triple P – Positive Parenting Program® (Triple P®) is a multi-tiered system of 5 levels of education and support for parents and caregivers of children up to age 16. Triple P® addresses child behavioural and emotional problems by helping parents learn how to apply techniques and strategies to different behavioural, emotional and developmental issues in children, such as aggressive behaviour, anxiety and attention deficit hyperactivity disorder (ADHD) related symptoms.
The 5 core principles of positive parenting embedded throughout the program promote social competence and emotional self-regulation in children:
- Ensuring a safe, engaging environment
- Promoting a positive learning environment
- Using assertive discipline
- Maintaining reasonable expectations
- Taking care of oneself as a parent.
Aims
- Improve the quality of parent-child relationships
- Improve parental stress and mental health
- Increase parents’ competence in managing behaviours problems
- Reduce parents’ use of coercive and punitive methods of discipline
- Improve parents’ personal coping skills and reduce stress
- Improve parents’ problem-solving skills
- Reduce child emotional and behavioural problems
- Reduce the intensity of disruptive child behaviour.
Impact
Evidence suggests that the Triple P® was effective in reducing out-of-home and foster care placement, with results observed for children up to age 8. Results were mixed in terms of reducing child maltreatment rates and interaction with child protection system. Families in the 2 included studies received varying levels and types of services offered by Triple P® depending on their needs.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Yes | Not found |
| System | Health service use | Yes | Yes | Not found |
| System | Out-of-home care | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
Triple P® has an evidence rating of Well-supported+.
This means that Triple P® has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 2 research outputs from one RCT and one QE. Triple P® has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design |
Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
The quality of the evidence in the included QE is low and results should be interpreted with caution.
The studies were conducted in the United States and do not include Aboriginal children and families. Triple P® is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The included studies were conducted in North Carolina and South Carolina, United States.
Sample characteristics
- The studies’ samples ranged from 18 counties (9 intervention, 9 control) in the RCT to 100 counties (34 intervention, 66 control) or 848,531 participants in the QE.
- In the QE, participants in the intervention group identified as Non-Hispanic White (59%), Hispanic Black (31%) and Hispanic (6%).
Implementation
Delivery model and mode
- Triple P® is delivered in-person, online and/or over the phone to a combination of the parent only, to both the parent and child, separately or together, in group formats with multiple parents, children and/or families and to the organisation.
Target cohort
- Parents with at least one child up to age 16.
Program delivery
- Triple P® is delivered through 5 levels of interventions:
- Level one is a universal communications campaign designed to raise awareness across the population with positive parenting information and messages. Stay Positive is the creative face of Universal Triple P®.
- Level 2 provides brief one-time assistance to parents who are generally coping well but have a couple of concerns with their child's behaviour or development. It is available for parents of children up to age 12 and for parents of teenagers and delivered as:
- Triple P® Selected Seminar Series or Teen Triple P® Seminar Series: 3 90-minute seminars attended by parents.
- Brief Primary Care or Brief Primary Teen: Practitioners provide regular support to parents through 15 to 30 minute, brief one-on-one consultations to target a specific issue.
- Level 3 is a targeted counselling for parents of children with mild to moderate behavioural difficulties. It is available for parents of children from birth to 12 years and for parents of teenagers with a specific problem behaviour or issue, and delivered as:
- Primary Care Triple P®: 15 to 30 minute face-to-face or telephone interventions with providers across approximately 4 individual consultations.
- Triple P® Discussion Groups: A 2-hour small group sessions targeting a specific problem behaviour or issue.
- Level 4 is a targeted intervention for parents of children with severe behavioural difficulties. It is available for parents of children from birth to 12 years and 12 to 16 years, and delivered as:
- Group Triple P®/Group Teen Triple P®: 5 small group sessions and are supported with 3 phone counselling/catch-up sessions at home.
- Standard Triple P®/Standard Teen Triple P®: Parents who need intensive support are provided an hour individual counselling delivered over 10 sessions.
- Triple P® Online: An 8-session web-based program that guides parents through Triple P®’s 17 core parenting skills.
- Self-directed Triple P®: A 10-week self-help program based on a workbook. Parents who need additional support can receive weekly 15 to 30-minute telephone consultations.
- Level 5 provides intensive support for families with complex concerns, delivered as:
- Enhanced Triple P®: Parents do up to 3 modules that target specific concerns. It is for parents who family situation if complicated by problems such as partner conflict, stress or mental health issues.
- Pathways Triple P®: Anger management and other behavioural strategies to improve a parent’s ability to cope with raising children. It is for parents at risk of child maltreatment.
Duration and intensity
- Level one may be planned for intermittent distribution of materials throughout the course of the Level 2 to 5; Stay Positive is typically planned as a 3-year implementation.
- Levels 2 to 3 may include up to 4 encounters that take place over one to 6 weeks.
- Level 4 to 5 typically take place over 4 to 5 months.
- If accommodations are needed, for low literacy clients for example, the duration may be longer.
Manuals and guides
- Triple P® has a standardised training and quality protocol that is used worldwide.
- All levels of Triple P® have intervention manuals, systematic training regimens for providers/practitioners, and coordinated resource materials for parents, including videos, workbooks and tip sheets. Translated materials are available in 21 languages.
Additional information
- The Triple P® website has more information about the program.
Staffing
- Triple P® provider training courses are usually offered to practitioners with a post-high school degree in health, education, childcare, or social services and some knowledge of child/adolescent development and/or have experience working with families.
Training
- Triple P® professional training courses are delivered by experienced trainers and involve:
- Attendance at a multi-day training program (2 to 3 days depending on the course level)
- Intensive self-review of intervention materials
- Competency practice and feedback at a day-long session
- Completion of a full-day pre-accreditation course, 4 to 6 weeks following training
- A half-day accreditation course held 6 to 8 weeks post training.
- The training process includes didactic instruction, modelling by the trainer, video examples of discrete skills, small-group exercises for active skills practice and group discussions of key issues.
To our knowledge, Triple P® is available in all states across Australia. It is not available in Australian Capital Territory or Northern Territory.
Triple P® is an Australian program developed by Triple P® International and Professor Matt Sanders and colleagues at the University of Queensland.
In Victoria, the State Government has supported free access to Triple P Online since June 2020. All families in Victoria can do free Triple P® programs to help support their child’s emotional wellbeing and family’s mental health. The Australian Triple P® website has more information about the program specific to the Victorian context.
Cost
We were unable to locate any information on the cost of Triple P®.
Triple P® is offered for free in most parts of Victoria, and some families may be eligible for a Medicare rebate on their Triple P® sessions. Triple P® Online is available for free to all families in Victoria.
References
Studies identified and included in the review
- Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ and Lutzker JR (2009). Population-based prevention of child maltreatment: The US Triple P system population trial. Prevention Science, 10(1):1-12.
- Schilling S, Lanier P, Rose RA, Shanahan M & Zolotor AJ (2020). A quasi-experimental effectiveness study of Triple P on child maltreatment. Journal of Family Violence, 35:373–383.
International studies identified but not counted towards the evidence rating due to study quality
- Sanders MR, Kirby JN, Tellegen CL & Day JJ (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34(4):337-357.
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2):171-202.
Australian studies identified but not counted towards the evidence rating due to study quality
- 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.
- 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.