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Triple P - Positive Parenting Programme

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Helping Vulnerable Children, Supporting Parenting and Assisting with Childcare

Recommendation Pillars

Enhance family support and the quality of alternative care settings

Countries that have implemented practice

Germany, Switzerland

Age Groups

Young Children (age 0 to 5), Middle Childhood (age 6 to 12)

Target Groups

Fathers, Mothers, Parents

Years in Operation

1999  - still operating

Type of Organization Implementing Practice

Private Health Care Organization, Private Education Organization

Practice Overview

The Triple P—Positive Parenting Programme is a multilevel system of family intervention that aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child.  According to the Triple P developers, apart from improving parenting skills, "the programme aims to increase parents' sense of competence in their parenting abilities, improve couples' communication about parenting, and reduce parenting stress. The acquisition of specific parenting competencies results in improved family communication and reduced conflict that in turn reduces the risk that children will develop a variety of behavioral and emotional problems" (Sanders, Turner, et al., 2002).

The programme has five intervention levels of increasing intensity and targeting, ranging from a community-wide media information campaign designed to reach all parents to an intervention for families identified as being at risk for child maltreatment.  The programme aims to engage the participating parent in the minimally sufficient intervention required in order to identify and improve parenting skills (Sanders, 1999).

This summary focuses on “Level 4” of the five levels, because this is the only level that has been evaluated in studies that meet the evidence criteria for inclusion on this site.  Level 4 can be delivered as a 10 session individual training programme or an 8 session group training programme focusing on teaching parents a range of parenting skills to target behavioral problems both in and outside the home.

Evidence of Effectiveness

 

Evaluation 1

 

Eighty-seven couples recruited via public advertisements in Swiss newspapers were randomized to receive the Triple P parent training program or to be in the control group.  Couples were assessed on their parenting skills and interactions with their child one year after the intervention (Bodenmann et al., 2008).

Summary of Results for Evaluation 1

 

Outcome

Mean Difference between Intervention and Control

Outcomes Improved (statistically significant)*

Parenting Scale among Mothers (lower is better)

  • Total

-5.52

  • Laxness

-1.66

  • Over reaction

-3.7

Parenting Scale among Fathers

  • Over reaction

-1.93

Parenting Sense of Competence among Mothers  (higher is better)

  • Total (self-esteem score)

3.74

  • Satisfaction

2.75

Parenting Problem Checklist  among Mothers (lower is better)

  • Burden

-1.74

Eyberg Child Behavior Inventory among Mothers (lower is better)

  • Problems

-9.71

  • Intensity

-3.69

Outcomes with No Effect

Parenting Scale among Fathers

  • Total

-2.87

  • Laxness

-0.83

Parenting Sense of Competence among Mothers

  • Self-efficacy

0.96

Parenting Sense of Competence among Fathers

  • Total (self-esteem score)

1.27

  • Satisfaction

-0.12

  • Self-efficacy

1.12

Parenting Problem Checklist  among Mothers

  • Frequencies

-1.97

Parenting Problem Checklist  among Fathers

  • Frequencies

-0.46

  • Burden

-0.56

Eyberg Child Behavior Inventory among Fathers

  • Problems

2.5

  • Intensity

-0.49

Dyadic Adjustment Scale among Mothers (higher is better)

  • Total

2.17

Dyadic Adjustment Scale among Fathers

  • Total

-2.52

* Outcomes improved had to demonstrate effects that were statistically significant at least at the 0.05 level.

 

Evaluation 2

Sixty-nine mothers and sixty-five fathers of children aged 3 to 6 were recruited from four preschools in Germany.  The parents were randomized to receive Level 4 of the Triple P program or to the control group.  The parents were assessed on their parenting skills and their child’s behaviour before and after the ten week intervention (Hahlweg, et al., 2008).

 

Summary of Results for Evaluation 2

 

Outcome

Intervention Group

Control Group

Post-test - Pre-test Difference

Post-test - Pre-test Difference

Outcomes Improved (statistically significant)*

Child Behavior Checklist - Parent Report among Mothers

  • Externalizing

-3.0

-0.6

  • Total

-10.3

-3.1

Strengths and Difficulties Questionnaire among Mothers

  • Total

-3.0

-0.4

Parenting Scale among Mothers

  • Over-reactivity

-0.8

0.0

  • Laxness

-0.4

0.0

  • Verbosity

-1.5

0.0

  • Total

-0.7

-0.1

Outcomes with No Effect

Child Behavior Checklist - Parent Report among Mothers

  • Internalizing

-1.9

-0.3

Child Behavior Checklist - Parent Report among Fathers

  • Internalizing

-2.9

-2.3

  • Externalizing

-6.9

-2.6

  • Total

-14.3

-8.3

Strengths and Difficulties Questionnaire among Fathers

  • Total

-2.5

-1.5

Positive Parenting Questionnaire among Mothers

  • Total

0.1

-0.1

Positive Parenting Questionnaire among Fathers

  • Total

0.1

0.1

Parenting Scale among Fathers

  • Over-reactivity

-0.3

-0.1

  • Laxness

-0.4

-0.1

  • Verbosity

-0.6

0.0

  • Total

-0.3

0.0

Center for Epidemiological Studies - Depression Scale among Mothers

  • Total

0.2

0.0

Center for Epidemiological Studies - Depression Scale among Fathers

  • Total

-2.5

-1.0

General Life Satisfaction Questionnaire among Mothers

  • Total

9.9

-0.1

General Life Satisfaction Questionnaire among Fathers

  • Total

10.3

8.0

Abbreviated Dyadic Adjustment Scale among Mothers

  • Total

0.5

-0.2

Abbreviated Dyadic Adjustment Scale among Fathers

  • Total

0.4

1.4

* Outcomes improved had to demonstrate effects that were statistically significant at least at the 0.05 level.

 

Evaluation 3

Seventeen preschools in Germany were randomized to receive Level 4 of the Triple P programme or to be in the control group.  In the eleven Triple P preschools, 186 parents participated and in the six control preschools, 94 parents participated.  All parents had a child attending the preschools between the age of 2.6 years and 6 years.  The behaviour of target children and the parents’ parenting skills were assessed at baseline, immediately following the intervention period, and at one year, and two years post-intervention (Hahlweg, et al., 2010).

Summary of Results for Evaluation 3

 

Pre-Intervention

Post-Intervention

One-Year Follow-Up

Two-Year Follow-Up

Intervention

Control

Intervention

Control

Intervention

Control

Intervention

Control

Outcomes Improved (statistically significant)*

Married Mothers

Positive Parenting Scale (higher is better)

2.07

2.08

2.16

2.08

2.14

2.06

2.08

1.99

Parent Scale (higher is better)

3.19

3.28

2.85

3.27

2.85

3.23

2.86

3.22

CBCL- Internalizing Scale (lower is better)

9.1

6.7

7.3

6.2

6.7

5.1

5.1

4.6

CBCL - Externalizing Scale (lower is better)

12.2

10.2

9.9

9.3

8.9

8.4

8.4

8.5

Married Fathers

Parent Scale (lower is better)

3.19

3.24

3

3.23

3

3.15

2.93

3.2

Outcomes with No Effect

Married Fathers

Positive Parenting Scale (higher is better)

1.88

1.92

1.88

1.95

1.88

1.88

1.8

1.79

CBCL- Internalizing Scale (lower is better)

8.6

5.2

6.9

4.7

5.9

4.4

3.8

3.2

CBCL - Externalizing Scale (lower is better)

11.8

10.9

10.2

9.3

8.7

9

7.8

7.6

Single Mothers

Positive Parenting Scale (higher is better)

2.17

2.16

2.17

2.24

2.14

2.22

2.08

2.06

Parent Scale (lower is better)

3.24

3.26

3.09

3.08

3.01

2.98

2.87

2.99

CBCL- Internalizing Scale (lower is better)

10.8

10

10.1

8.1

12.1

7.3

7.9

4.9

CBCL - Externalizing Scale (lower is better

13

12.6

13.1

9.5

13.4

9.4

11.6

8.5

*Outcomes improved had to demonstrate effects that were statistically significant at least at the 0.05 level.

Transferability

This programme has been implemented and evaluated in Switzerland and Germany.  Both studies found positive impacts of Triple P as shown above.  In the study in Switzerland, Triple P was found to be effective in improving parenting skills, parents’ sense of competence, and parents’ ratings of parenting problems and child behavioral problems (Bodenmann et al., 2008).  These effects were seen among mothers but not among fathers, with the exception of rating of over-reactive parenting style which improved among mothers and fathers.  In the two studies in Germany, Triple P was found to be effective in improving parenting skills and parent’s ratings of child behavioral problems (Hahlweg et al., 2008; Hahlweg et al., 2010).  As with Bodemann et al. (2008), these studies also found these effects among mothers but not among fathers.  The study conducted by Hahlweg et al. (2010) did find that Triple P was effective at improving parental discipline techniques among fathers.

Enduring Impact

The effect of Level 4 of the Triple P programme on parenting skills and child behavior was found to be sustained through at least two years post-intervention (Hahlweg et al., 2010).

Issues to Consider

In both evaluations, effects of the Triple P programme were seen among mothers but not among fathers, with the exception of rating of over-reactive parenting style which improved among mothers and fathers in the evaluation by Bodemann et al. (2008) and parenting skills which improved among married mothers and fathers in the evaluation by Hahlweg et al. (2010).  While the Hahlweg et al. (2010) found positive effects of Triple P on married mothers, there were no effects found for single mothers.

Contact Information

Name

Kurt Hahlweg, PhD

Title

Professor

Organization

Technical University of Braunschweig

Address

Institut für Psychologie
Abteilung für Klinische Psychologie
Psychotherapie und Diagnostik
Spielmannstraße 12a
38106 Braunschweig
Germany

Email

k.hahlweg@tu-bs.de

Available Resources

Triple P has developed a wide range of resources and curricular materials for organizations and practitioners. Those can be found at the Triple P website:

http://www.triplep-america.com/pages/resources/description.html

Triple P materials are available in English and Spanish.

Evaluation Details

Bodenmann et al. (2008) conducted an evaluation of Triple P in Switzerland. Eighty-seven couples recruited via public advertisements in Swiss newspapers were randomized to receive Level 4 of the Triple P parent training programme or to be in the control group. In this setting, the Level 4 Triple P intervention offered all parents the opportunity to learn about more positive parenting and was not restricted to parents of children with known behavioural problems. Parents in the intervention group participated in four group parent training sessions and four individual consultations over the phone. The goal of the intervention was to teach parents child management strategies aimed at promoting competence and development, and at managing misbehaviour. Couples were assessed on their parenting skills and interactions with their child one year after the intervention. For some couples, only the mother or father participated in the study.

The intervention improved outcomes for mothers at the one-year follow-up when compared to the control group mothers. The outcomes which improved included:

  • Ratings of parental discipline including laxness and over-reactivity
  • Ratings of parenting competence including satisfaction and self-esteem
  • Rating of the burden of inter-parental conflict
  • Ratings of the frequency and intensity of the child’s disruptive behavior

Mother’s ratings of the quality of their relationship with their partner did not differ significantly between the intervention and control groups. Mother’s ratings of frequency of inter-parental conflict and parental self-efficacy also did not differ between the intervention and control groups.

Among fathers, only ratings of an over-reactive parental discipline style improved for the intervention group compared to the control group at one-year follow-up. There were no other significant differences among fathers in the intervention and control groups at the one-year follow-up.

Hahlweg et al. assessed Level 4 of the Triple P programme in Germany. Sixty-nine mothers and sixty-five fathers of children aged 3 to 6 were recruited from four preschools in Germany. The parents were randomized to receive Level 4 of the Triple P programme or to the control group. The Level 4 intervention in this study did not include group sessions but included telephone consultations with parents. Parents in the intervention group received seven weekly consultations with the goal of improving the parents’ problem-solving skills. Parents were also provided with the “Every Parent’s Self Help Workbook” and were asked to complete sections of this work book each week for ten weeks. The parents were assessed on their parenting skills and their child’s behaviour before and after the ten week intervention.

Among mothers, there were significant differences between the intervention and control groups on the following outcomes:

  • Ratings of child behavioral problems including conduct problems and overall behavioral issues.
  • Ratings of parental discipline techniques including over-reactivity, laxness, and verbosity (which is defined as “overly long reprimands or reliance on talking (Halweg et al., 2008)”)

There were no differences in mothers’ ratings of positive parenting behaviors, general life satisfaction, depression, or quality of parental relationships.

After the intervention, there were no significant differences between fathers in the intervention group and in the control group as assessed by several scales measuring child’s behavioral problems, positive parenting behaviors, parental discipline styles, general life-satisfaction, depression, and quality of parents’ relationships.

Hahlweg et al. (2010) assessed the effect of Level 4 of the Triple P programme among parents of children aged 2.6 to 6 years enrolled in preschools in Germany.  Seventeen preschools were randomized to receive Level 4 of the Triple P programme or to the control group.  In the eleven Triple P preschools, 186 parents participated and in the six control preschools, 94 parents participated.  Parents in the intervention preschools participated in 4 weekly group sessions and 4 optional weekly phone calls.  In the group sessions, parents were taught parental management strategies focusing on promoting their children’s competence and development, and managing their children’s misbehavior. The behaviour of target children and the parent’s parenting skills were assessed at baseline, immediately following the intervention period, and at one year, and two years post-intervention (Hahlweg, et al., 2010).  Married mothers, married fathers, and single mothers were assessed separately in this evaluation.

 

Among married mothers, Triple P was found to have positive effects on the following outcomes immediately following the intervention and at one and two years post-intervention:

  • Ratings of child behavioral problems including conduct problems and overall behavioral issues as assessed by the parent and by the preschool teacher.
  • Ratings of parental discipline techniques including over-reactivity, laxness, and verbosity.
  • Ratings of positive and encouraging parenting behaviors, such as cuddling with one’s child.

Among married fathers, Triple P was found to have positive effects on ratings of parental discipline techniques including over-reactivity, laxness, and verbosity.at post-intervention, and at one and two years post-intervention.  There were no significant effects found on child behavioral problems among the target children of married fathers.

There were no significant effects of the Triple P programme found among single mothers on parental discipline, positive parenting behaviors, or child behavioral problems.

Bibliography

Bodenmann, G., A. Cina, et al., "The Efficacy of the Triple P-Positive Parenting Program in Improving Parenting and Child Behavior: A Comparison with Two Other Treatment Conditions,"   Behavior Research and Therapy, Vol. 46, No. 4, 2008, pp. 411-427.

Hahlweg, K., N. Heinrichs, et al., “Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program:  is it worth the effort?,” Child and Adolescent Psychiatry and Mental Health, Vol. 4, No. 14, 2010, pp. 1-14.

Hahlweg, K., N. Heinrichs, et al., "Therapist-Assisted, Self-Administered Bibliotherapy to Enhance Parental Competence: Short- and Long-Term Effects,"   Behavior Modification, Vol. 32, No. 5, 2008, pp. 659-681.

Sanders, M. R., "Triple P-Positive Parenting Program: Towards an Empirically Validated Multilevel Parenting and Family Support Strategy for the Prevention of Behavior and Emotional Problems in Children,"   Clinical Child and Family Psychology Review, Vol. 2, No. 2, 1999, pp. 71-90.

Last Updated

November 2012