An intensive support program for families with complex concerns, designed to prevent and treat behavioural and emotional problems in children and teenagers.
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
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
The Triple P Level 5 program offers intensive support for families with complex concerns. It is an adjunct intervention (alongside a Level 4 Triple P program) to address family factors that might impact parenting and behavioural and emotional problems in children and teenagers. Triple P Level 5 is designed for parents at risk of child maltreatment and whose family situation is complicated by problems such as partner conflict, stress or mental health issues. Triple P Level 5 is delivered as:
- Enhanced Triple P: For parents whose family situation is complicated by problems such as partner conflict, stress or mental health issues. Three modules target specific concerns. Parents can do one, two or three of the modules which work on partner relationships and communication, personal coping strategies for high stress situations and other positive parenting practice.
- Pathways Triple P: For parents at risk of child maltreatment. Covers anger management and other behavioural strategies to improve a parent's ability to cope with raising children.
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
The evidence is mixed and inconclusive for most of the child and family outcomes measured.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| Child | Mental health/behaviour | Yes | Yes | Not found |
| Family | Functioning | Yes | Yes | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Yes | Yes |
| Parent/caregiver | Parenting skills | Yes | Yes | Not found |
| Parent/caregiver | Social support | Not found | Not found | Yes |
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 Level 5 has an evidence rating of Well-supported.
This means that Triple P Level 5 has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, short-term impact on at least one child and family outcome. Some studies included a one-year follow up post intervention, but because no control group was included, findings from the follow up were not included. As such, there was insufficient evidence to assess sustained impact beyond the intervention.
This assessment is based on 4 research outputs from 4 RCTs. Triple P Level 5 has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
The program's evidence base is reasonably strong given the size and number of the trials conducted in the Australian context.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 4 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of the evidence from the included studies. When interpreting the results, it is important to note that the evidence is supported by 4 primary RCTs.
The studies were conducted in Australia but we do not have sufficient information to know if Aboriginal children and families were included in the studies.
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
- All 4 RCTs were conducted in Australia; 3 in Queensland and one across both New South Wales and Queensland.
Sample characteristics
- The trials’ sample sizes ranged from 21 families (10 intervention, 11 control) to 305 families (76 intervention one, 77 intervention 2, 75 intervention 3, 77 control).
- The study was conducted in Australia, but we were unable to locate information on sample characteristics specific to Aboriginal children and families.
Implementation
Delivery model and mode
- Triple P Level 5 is delivered in-person, online and/or over the phone, to the parent only or in a group format with multiple parents, children and/or families.
Target cohort
- Triple P Level 5 is delivered to parents with children up to age 12 presenting with family issues such as stress, poor coping, and/or partner conflict. They have usually completed a Level 3 or Level 4 program and require extra support to make or maintain changes in parenting.
Program delivery
- 3 modules target specific concerns. Parents can do one, 2 or 3 of the modules which work on partner relationships and communication, personal coping strategies for high stress situations and other positive parenting practice.
- Enhanced Triple P consists of 4 different modules delivered to families in 3 to 8 individualised consultations. The modules address family factors that may impact upon and complicate the task of parenting, such as parental mood and partner conflict.
- Session one: Practitioners conduct a progress review interview and negotiate a treatment plan.
- Module one: Conducted in the family’s home or a community setting to provide the parent with opportunities to practice and receive personalised feedback on how they apply skills introduced in the Level 3 or Level 4 program.
- Module 2: Parents learn a range of cognitive and behavioural strategies to cope with everyday stress and emotions.
- Module 3: Parents learn a variety of positive communication, problem-solving, conflict resolution skills to enhance their teamwork as parenting partners.
- Module 4: Parents practice all skills with minimal support. Their progress is reviewed through the program as they plan goals for the future.
- Practitioners should allow time for preparing for the sessions, supervision and case notes/report writing.
Duration and intensity
- Families need to be able to commit to 3 to 8 sessions depending on their indicated needs.
- Consultations last 8 to 12 hours in total (for 8, 60- to 90-minute sessions) based on an average of 2 modules completed per family in addition to a Level 4 program.
Manuals and guides
- Triple P Level 5 uses the tools and Implementation Framework of the general Triple P system, including the organisational readiness checklist, supervisor/manager readiness form, practitioner selection/fit form and community assessment/implementation milestones checklist.
Additional information
- The Triple P website has more information explaining the level 5 system.
Staffing
- We were unable to locate any information on staffing requirements specific to Triple P Level 5. Under the Triple P system, 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
- We were unable to locate any information on training requirements specific to Triple P Level 5. Under the Triple P system, training is condensed into a series of intensive workshops over 2 to 3 days. Training is delivered either on site at a large organization or in other public venues within a city or town. Triple P International can arrange venues, catering and handle other set-up details if needed. Open-enrolment Triple P training for individual practitioners is also offered in many locations. Organisations, agency, jurisdiction or governments coordinating the Triple P rollout must have ongoing support and guidance.
To our knowledge, Triple P Level 5 is available in all states across Australia. It is not available in Australian Capital Territory or Northern Territory.
There are Specialist Triple P programs delivered with an indigenous focus. Aboriginal-led knowledge is embedded in the Indigenous Triple P program; materials and content were created in consultation with elders from remote and urban Aboriginal communities in Australia.
The Triple P system is an Australian program developed by Triple P International and Professor Matt Sanders and colleagues at the University of Queensland. 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 Level 5.
The Triple P system is offered for free in most parts of Victoria. At providers that charge a fee, 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
- Hoath F & Sanders M (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.
- Sanders MR, Markie-Dadds C, Tully LA & 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.
- Stallman HM & Sanders MR (2014). A randomized controlled trial of Family Transitions Triple P: A group-administered parenting program to minimize the adverse effects of parental divorce on children. Journal of Divorce & Remarriage, 55(1): 33-48.
- Wiggins TL., Sofronoff K & Sanders MR (2009). Pathways Triple P-Positive Parenting Program: Effects on parent-child relationships and child behavior problems. Family Process, 48:517–530.
Studies identified but not counted towards the evidence rating due to study quality
- Bor W, Sanders MR & 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.
- 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.