Study Review

Triple-P Parenting Programme

The Triple-P Parenting Programme is a multi-level system of support to prevent and treat social, emotional and behavioural problems in children by enhancing parent knowledge, skills and confidence.

Outcome Overall
effectiveness

This rating shows how effective the intervention is at achieving the evaluated outcome.

Click here for information about how effectiveness ratings are applied.

 Strength of
evidence

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.
Child social, emotional and behavioural outcomes (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Child observations (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parenting practices (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parenting satisfaction and efficacy (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parental adjustment (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parental relationship (both parents) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parent observations (both parents) Overall effectiveness: mixed (maximum 2) Strength of evidence : 3 (maximum 3)
Child social, emotional and behavioral outcomes (fathers) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Child observations (fathers) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parenting practices (fathers) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parenting satisfaction and efficacy (fathers) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parental adjustment (fathers) Overall effectiveness: 0 (maximum 2) Strength of evidence : 3 (maximum 3)
Parental relationship (fathers) Overall effectiveness: 2 (maximum 2) Strength of evidence : 3 (maximum 3)
Parent observations (fathers) Overall effectiveness: 0 (maximum 2) Strength of evidence : 3 (maximum 3)

Headline points

  • This summary comes from the original systematic review: Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (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
  • The Triple-P Parenting Programme is a system involving five different levels of intervention, ranging from very low intensity to high intensity.
  • Triple-P can act as a common pathway to improve both short-term and long-term social, emotional and behavioural (SEB) outcomes in children.
  • The intervention can improve broader parenting outcomes including parenting practices, parenting confidence, parental relationships and parental adjustment. Further research into the pathways that foster change across the child and parent outcomes is needed.
  • These findings are based upon high strength evidence, comprising 97 trials and including 62 randomised controlled trials, indicating we can have strong confidence in the results. However, insufficient reporting across the studies limited the extent to which bias could be calculated.
  • Only six studies were undertaken in the UK, with most studies conducted in Australia.

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What is this?

The parenting a child receives affects many aspects of their health and well-being. Children raised with warm, supportive parenting are less likely to develop antisocial behaviours, irrespective of social deprivation or low socio-economic status. Consequently, interventions aimed at improving parenting are commonly used to enhance child outcomes. Of these, the most empirically supported programmes are the Incredible Years Programme and the Triple P-Positive Parenting Programme.

How is it meant to work?

  • Triple-P is based on a minimal sufficiency principle, where meaningful change can be achieved in the most efficient and cost-effective manner.
  • Triple-P combines social learning theory (SLT) with a public health approach. SLT is deemed the ‘gold standard’ at promoting childhood wellbeing and preventing behavioural problems, as outlined by organisations such as the United Nations, and the World Health Organisation.
  • Triple-P includes five levels of intervention using a tiered system, including universal, targeted and treatment interventions.

What are the evaluated outcomes?

All outcomes were examined for both parents and fathers only. Evidence ratings are given for both parents first, followed by fathers only.

  • Child social, emotional and behavioural outcomes
  • Child observations
  • Parenting practices
  • Parenting satisfaction and efficacy
  • Parental adjustment
  • Parental relationship
  • Parent observations

What are the evaluated outcomes?

  • Child social, emotional and behavioural outcomes (both parents)
  • Child observations (both parents)
  • Parenting practices (both parents)
  • Parenting satisfaction and efficacy (both parents)
  • Parental adjustment (both parents)
  • Parental relationship (both parents)
  • Parent observations (both parents)
  • Child social, emotional and behavioral outcomes (fathers)
  • Child observations (fathers)
  • Parenting practices (fathers)
  • Parenting satisfaction and efficacy (fathers)
  • Parental adjustment (fathers)
  • Parental relationship (fathers)
  • Parent observations (fathers)

How effective is it?

This summary is based on a meta-analysis of Triple-P, meaning that the results of previous research are systematically assessed to derive conclusions about this body of research. Unlike previous meta-analyses of Triple-P that have focused on single outcomes, this review considered seven outcomes which Triple-P aims to address, and includes both parents and fathers only in its findings.

Child social, emotional and behavioural outcomes
For both parents, Triple-P had a consistently positive effect on child social, emotional and behavioral (SEB) outcomes, meaning that Triple-P positively and consistently influences child SEB outcomes. When child SEB outcomes were examined for fathers only, this yielded the same result.

Child observations
For both parents, Triple-P had a consistently positive effect on child observations, meaning that Triple-P positively and consistently influences child observations. When child observations were examined for fathers only, this yielded the same result.

Parenting practices
For both parents, Triple-P had a consistently positive effect on parenting practices, meaning that Triple-P positively and consistently influences parenting practices. When parenting practices were examined for fathers only, this yielded the same result.

Parenting satisfaction and efficacy
For both parents, Triple-P had a consistently positive effect on parenting satisfaction and efficacy, meaning that Triple-P positively and consistently influences parenting satisfaction and efficacy. When parenting satisfaction and efficacy was examined for fathers only, this yielded the same result.

Parental adjustment 
For both parents, Triple-P had a consistently positive effect on parental adjustment, meaning that Triple-P positively and consistently influences parental adjustment. However, when parental adjustment was examined for fathers only, Triple-P had no effect on this outcome, meaning that the balance of evidence suggests the intervention has no (positive or negative) effect overall on parental adjustment for fathers.

Parental relationship 
For both parents, Triple-P had a consistently positive effect on parental relationship, meaning that Triple-P positively and consistently influences parental relationship. When parental relationship was examined for fathers only, this yielded the same result.

Parent observations
For both parents, Triple-P had a mixed effect on parent observations, in the short term there was no effect but at follow-up a small effect was identified. However, when parent observations were examined for fathers only, Triple-P had no effect on this outcome, meaning that the balance of evidence suggests the intervention has no (positive or negative) effect overall on parent observations for fathers only.

How strong is the evidence?

  • The impact of Triple-P was found to be consistent across the papers.
  • Future studies are needed from independent research teams because this meta-analysis was conducted by Triple-P developers. Nevertheless, the 31 studies included in the review with no developer involvement still found a significant effect for child social, emotional and behavioural outcomes.
  • Insufficient reporting across the studies limited the extent to which bias could be calculated
  • The review is limited by its reliance on parent self-report measures.
  • All of the above findings are based on high strength evidence, indicating a high quality review in which strong confidence can be placed.

Where has it been studied?

The 97 trials were undertaken in 13 countries including a range of cultural and ethnic groups. Most studies were conducted in Australia (n = 58). Six studies were undertaken in the UK.

Who does it work for?

  • Children ranged from birth to 18 years with a mean age of 5.85. Slightly more boys were included in the sample than girls (60.7%).
  • Rate of child problems at baseline ranged from 0 – 67% with an average of 59.
  • Of the 101 studies, 27 included separate findings for fathers.
  • Insufficient reporting across the studies limited the extent to which key potential moderators could be examined e.g. socioeconomic status and race/ethnicity of child and parent. This means, for example, we cannot know the strength of the relationship between child SEB outcomes and Triple-P for different demographics.

When, where and how does it work?

  • The trials included in the review adopted different approaches: universal, targeted, or treatment, and while all three approaches had significant effects, the targeted and treatment interventions had larger effect sizes than universal approaches.
  • Triple-P can be delivered in five different formats: standard, group, self-directed, self-directed and telephone or online delivery. Online delivery had the largest impact on child social, emotional and behavioural outcomes while online and group delivery had the largest impact on parenting relationship.
  • The review considered a range of programme variants for level four interventions (see Implementation section for further details). Each programme variant was based on common theory and strategies but each variant had unique content and targeted a different population, for example the 0 – 12 years programme, Teen Triple-P, Stepping Stones Triple-P (for parents of children with a disability) and Workplace Triple-P (a work assistance programme). These programmes influenced parenting practices in different ways, but no difference between variants was found for child SEB outcomes, parenting satisfaction and efficacy, or parental relationship.
  • Further research into the pathways that foster change across the child and parent outcomes is needed.

What are the costs and benefits?

No economic analysis is included in the study.

How is it implemented?

According to the Triple-P website, the implementation of Triple-P can take several forms e.g. a ‘population approach’, whereby the organisation offers interventions from all levels (intensities) of Triple P and considers a range of delivery types e.g. one-on-one, groups and/or online. Or the implementation in an organisation can adopt more of a ‘tailored approach’ whereby the organisation selects one or several Triple P courses that suit the needs of the targeted families. Or, individuals can choose to enrol on courses themselves.

The Triple-P Parenting Programme is a system involving five different levels of intervention.

Level 1
Level one is very low intensity, comprising a communication and media strategy to promote engagement amongst parents and members of the community for child development or to prevent or manage common social, emotional or behavioural issues. Level one involves television and radio programmes as well as printed or electronic media to raise awareness.

Level 2
Level two is low intensity, consisting of brief interventions targeted at parents who want general parenting information and advice, or with specific concerns about their child’s development or behaviour, e.g. bedtime routines. Level two includes a series of 90-minute stand-alone large group parenting seminars, or one or two brief individual face-to-face or telephone consultations, lasting around 20 minutes.

Level 3
Level three is low to moderate intensity, aimed at parents with specific concerns and who require brief consultations and active skills training. This is delivered via a brief programme lasting around 80 minutes over three to four individual face-to-face or telephone sessions.

Level 4
Level four is moderate to high intensity for parents wanting intensive training in positive parenting skills. This consists of around ten hours, with delivery options including ten 60-minute individual sessions; or five 2-hour group sessions with three brief telephone or home visit sessions; or ten self-directed workbook modules; or eight interactive online modules. This approach is also geared towards parents of children with disabilities who have, or who are at risk of developing behavioral or emotional problems. The method of delivery involves a targeted program involving ten 60-90 minute individual sessions or 2-hour group sessions.

Level 5
Level five is a high intensity family intervention aimed at parents of children with behaviour problems and concurrent family dysfunction such as parental depression or stress, or conflict between partners, parents at risk of abusing their children, parents who are separating or parents of children who are overweight or obese. The method of delivery varies as sessions are tailored to family needs. Level five may include  individually tailored sessions ranging from three 60 minute sessions to eight 60 minute sessions, home visits, or around 12 intensive weekly sessions including telephone consultations.

Who can deliver it?

The Triple-P website outlines that ‘a competency-based accreditation process is a critical component of all Triple P training courses…to ensure that Triple P will be delivered competently and successfully within the community’.

What are the training and supervision requirements?

According to the Triple-P website:

‘All Triple P training is coordinated by Triple P International, which has a network of trainers around the world, ready to train new practitioners in many countries. Depending on the number of participants you have, trainers can come to your workplace – delivering on site at a large organization – or can run training for you in other public venues within a city or town. Open-enrollment Triple P training for individual practitioners is also offered in many locations. All Triple P trainers are extensively trained in the Triple P programs and have minimum qualifications of a Masters (or equivalent) in educational or clinical psychology’.

What supports good implementation

The Triple-P website states implementation support is offered to individuals and organisations. There’s also an Implementation Framework comprising of five phases:

Engagement
Commitment and Contracting
Implementation Planning
Training and Accreditation
Implementation and Maintenance

‘Each phase contains a set of critical activities to be addressed by an organization or community. For each set of activities, guiding questions and discussion areas, tools, and resources are available’.

 

In summary...

  • For both parents, and fathers only, Triple-P had a consistently positive effect on child SEB outcomes, child observations, parenting practices, parenting satisfaction and efficacy, and parental relationship.
  • For both parents, Triple-P had a positive effect on parental adjustment, whilst when examined for fathers only the intervention had no effect on this outcome. For fathers only Triple-P also had no effect on parent observations, whilst for both parents Triple-P had a mixed effect on parent observations.
  • Triple-P level of intensity and severity of child problems influenced the strength of the relationship between child and parent outcomes and Triple-P.
  • There’s a need for further independent evaluation of Triple-P and for this research to be conducted in the UK. Further research should also include the impact of fathers on child and family outcomes. To do this, research should detail the number of fathers recruited and report their data separately.

Further resources

This summary comes from an original systematic review:

Sanders, M., Kirby, J., Tellegen, C. and Day, J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Child Psychology Review, 34, 337-357.