Triple P

About the program

Triple P is a population-level system of parenting and family support.  It includes five intervention levels of increasing intensity and narrowing population reach.

The program is designed to enhance parental competence, and prevent or alter dysfunctional parenting practices. It aims to reduce risk factors both for child maltreatment and for children’s behavioural and emotional problems.

All services in the Triple P system incorporate five positive parenting principles:

1. ensuring a safe, engaging environment
2. promoting a positive learning environment
3. using assertive discipline
4. maintaining reasonable expectations
5. taking care of oneself as a parent

The program emphases parents learning how to apply these skills to different behavioral, emotional and developmental issues in children, ranging from common child-rearing challenges (e.g., toileting, mealtime behavior, bedtime, behaviour in public) to more intense challenges (e.g., child aggressive behavior, fears and anxiety, ADHD difficulties).

The five positive-parenting principles translate into 35 specific strategies and parenting skills in eight different categories:

• parent–child relationship enhancement
• encouraging desirable behavior
• teaching new skills and behaviors
• managing misbehavior
• preventing problems in high-risk situations
• self-regulation skills
• parental mood management and coping skills
• partner support and communication skills

Triple P provides developmentally tailored menu options that facilitate parental goal setting and self-regulation. Parents learn how to apply those techniques and strategies that are relevant to their child, the parent’s goals, and the family situation.

It was developed by Sanders and colleagues (Sanders 1999; Sanders et al. 2002), at the University of Queensland, in Australia.

See also the following Program Summaries in the Preventing Child Maltreatment Evidence Review:

• Group Teen Triple P
• Triple P - Enhanced group behavioural family intervention

See also the Self-Directed Triple P Program Summary in the Reducing Child Harm and Maltreatment Evidence Review.

Who does it work for?

Triple P is a program designed for population level implementation, targeting parents who have children 17 years and under.

The program has been evaluated in the USA (Prinz et al. 2009, Schilling et al. 2019).

• One population trial was conducted with an average of 85,000 families per year of the intervention, held over two years (85,000 families were part of the intervention group per year and over 99,000 families were part of the control group). On average, children were 0-8 years old. One third of families were African American, and 15% were considered living in poverty (Prinz et al. 2009).
• One quasi-experimental design trial was conducted with 23,723 children receiving the Triple P program. On average, most families were Caucasian and 25% of children were living in poverty (Schilling et al. 2019).

Triple P has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive Outcomes:

• Child abuse reports:
  • Rates of child maltreatment reports were lower in populations receiving Triple P than in populations receiving standard intervention (Prinz et al. 2009).
  • Risks of investigated child maltreatment is lower in populations receiving Triple P than in populations receiving standard intervention (Schilling et al. 2019).
• Child hospitalisations: Child maltreatment injuries recorded in hospitals by medical personnel decreased for populations receiving the Triple P intervention (Prinz et al. 2009).
• Removal of child from caregiver:
  • Child out of home placements decreased for populations receiving Triple P (Prinz et al. 2009).
  • Rates of children in foster care decreased in populations receiving Triple P (Schilling et al. 2019).

No Effect:

• Child hospitalisations: the program shows no effect on the relative risk of emergency department visits due to suspected child abuse (Schilling et al. 2019).

Negative Outcomes:

• No negative effects were found.

How effective is it?

Overall, Triple P has a positive effect on client outcomes.

How strong is the evidence?

Supported research evidence:

• At least two high-quality randomised controlled trial (RCT) studies report statistically significant positive effects for at least one outcome, AND
• Fewer RCT studies of similar size and quality show no observed effects than show statistically significant positive effects for the same outcome(s), AND
• No RCT studies show statistically significant adverse effects.

How is it implemented?

The Triple P program uses a multi-tiered individualised approach so all parents receive a minimally sufficient level of service. There are a variety of delivery methods available to provide flexibility to meet the needs of individual families and communities.

All levels of Triple P have intervention manuals that have been carefully developed, systematic training regimens for providers/ practitioners, and coordinated resource materials for parents (videos, workbooks, and tip sheets).

The program consists of five levels of interventions:

Level 1: Universal Triple P

Involves implementing media and informational strategies about positive parenting. These strategies are intended to de-stigmatise parenting and family support, make effective parenting strategies readily accessible to all parents, and facilitate help-seeking and self-regulation by parents who need higher intensity intervention. It includes use of radio, local newspapers, newsletters at schools, mass mailings to family households, presence at community events, and website information.

Level 2: Selected Triple P

Has utility for many parents and is intended to normalize parenting interventions. There are two delivery formats:

1. brief and flexible consultation with individual parents. This involves 1-2 20min consultations. It is designed for parents with relatively minor and discrete problem behaviours that do not require more intensive intervention. This is a useful and non-threatening strategy to help parents begin to address their own parenting behaviours in the context of their asking for information or assistance about their child’s behavior. The intervention can be provided in the context of childcare, daycare and preschool settings, and in other settings where parents may have routine contact with service providers and other professionals who regularly assist families.
2. parenting seminars with large groups of parents. This involves three 90-min sessions. The seminar series includes specific seminars on: The Power of Positive Parenting; Raising Confident, Competent Children; Raising Resilient Children. The three seminars are independent of each other so parents can attend any or all. Seminars are used to promote awareness of Triple P and as brief and informative sessions for any parent. Each seminar includes a presentation, a question and answer period, distribution of a parenting tip sheet, and availability of practitioners at the end of the session to deal with individual inquiries and requests for further assistance.

Level 3: Primary Care Triple P

For parents of children with discrete child problem behaviours. Provision of advice and information is supported by active skills training for parents. This level is appropriate for parents of infants, toddlers, and preschoolers with common child behavior problems and parenting challenges. Level Three involves a series of four brief (20-min) consultations that incorporate active skills training and the selective use of parenting tip sheets covering common developmental and behavioural problems of preadolescent children. This brief and flexible consultation also builds in general enhancement strategies for teaching parents how to apply knowledge and skills gained to non-targeted behaviors and other children in the family.

Level 4: Standard and Group Triple P

For parents of children with more severe behavioural difficulties or who are struggling with parenting challenges. Parents learn child management skills and how to apply these skills both at home and in the community.

Level 4 combines the provision of information with active skills training and support, as well as teaching parents to apply skills to a broad range of target behaviors in both home and community settings with the target child and siblings. Two different delivery formats are available:

1. Standard: a 10-session program (up to 90 min per session) with individual families that utilizes active skills training methods, as well as home visits or clinic observation sessions (40–60 min each)
2. Group: An 8-session group-administered program which employs an active skills training process; consists of five 2- h group sessions that provide opportunities for parents to learn through observation, discussion, practice and feedback; three 15–30 min follow-up telephone sessions provide additional support to parents as they put into practice what they have learned in the group sessions.

Level 5: Enhanced Triple P

An optional addition to Level 4. For Families with additional risk factors. Includes optional intervention modules on partner communication, mood management and stress coping skills for parents, and additional practice sessions addressing parent–child issues.

How much does it cost? Information can be found on the Triple P website: https://www.triplep.net/glo-en/home/

What else should I consider?

Triple P professional training courses delivered by experienced trainers involve:

• Attendance at a multi-day training program (2 or 3 days, depending on course level)
• Intensive self-review of intervention materials
• Competency practice and feedback at a day-long session
• Completion of accreditation requirements.

Where does the evidence come from?

One population trial conducted across 18 counties in the USA with a sample of 85,000 families (Prinz et al. 2009).

One quasi-experimental design study conducted in the USA with 23,723 children (Schilling et al. 2019).

Further resources

Triple P – Positive Parenting Program website: https://www.triplep.net/glo-en/home/

Prinz et al. (2009), Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial, Prevention Science, Vol. 10, pp. 1-12.

Schilling et al. (2019), A Quasi-Experimental Effectiveness Study of Triple P on Child Maltreatment, Journal of Family Violence, Vol. 35, pp. 373-383.