Program Goals

The goals of Triple P - Positive Parenting Program® System (System Triple P) are:

• Prevent development, or worsening, of severe behavioral, emotional and developmental problems in children and adolescents by enhancing the knowledge, skills, and confidence of parents
• Increase parents' competence in promoting healthy development and managing common behavior problems and developmental issues
• Reduce parents' use of coercive and punitive methods of disciplining children
• Increase parents' use of positive parenting strategies in managing their children's behavior
• Increase parental confidence in raising their children
• Decrease child behavior problems (for families experiencing difficult child behavior)
• Improve parenting partners' communication about parenting issues
• Reduce parenting stress associated with raising children

Logic Model

View the Logic Model for Triple P - Positive Parenting Program® System (System Triple P).

Essential Components

The essential components of the Triple P - Positive Parenting Program® System (System Triple P) include:

• Uses practitioners who are trained to create a supportive learning environment for parents to receive and discuss practical information about parenting skills that they can incorporate into everyday interactions with their children
• Uses a multi-level system of interventions:
• Level 1 is a comprehensive media campaign and distribution strategy for delivering positive parenting information to all families within a given community.
• Level 2 interventions are delivered to parents through low-intensity seminars or single-session meetings.
• Level 3 interventions are brief in duration (1-4 sessions) and focus on identifying and resolving commonly encountered behavior problems in childhood. Level 3 interventions may be offered in a variety of settings where parents naturally visit.
• Level 4 interventions are delivered in 8-10 sessions and offer parents a more comprehensive set of strategies for improving family functioning and parent-child relationships in any situation. The interventions have sufficient impact to address moderate to severe behavior problems in children.
• Level 5 interventions offer further support for parents with specific risk factors (e.g., families at high risk for child maltreatment, families going through a divorce or separation, or families with overweight or obese children) or for parents with continuing needs following a Level 4 intervention.
• Uses developmentally appropriate interventions with a variety of media:
• System Triple P provides a program designed for infants, toddlers, preschoolers and elementary school-aged children, as well as a distinct program for early teens.
• In each distinct developmental stage (i.e., infants, toddlers, preschoolers, primary school children, early teens, and teens), Triple P provides single behavior tip sheets for common behaviors that parents ask about.
• System Triple P interventions are delivered with a variety of resources used in session and later in assigned homework to impart information and to provide a parent with practice exercises when at home. In Levels 2-3, parents will receive specific "tipsheets" to try out. In Levels 4 - 5, parents work through a workbook with more involved practice exercises.
• System Triple P uses implementation resources that include the following:
• Level 1 uses a Parent Tippaper, brochures, posters, newspaper columns, radio/TV/text messages, and parent, practitioner, and agency websites.
• Level 2 uses parent tipsheets, practitioner group presentations, and a DVD for parent viewing.
• Level 3 uses parent tipsheets, parent discussion booklets, a DVD for parent viewing, and a practitioner flip chart.
• Level 4 uses parent workbooks, parent DVD collections, practitioner presentations, a self-directed workbook, and an online application.
• Level 5 uses parent workbooks, parent DVD collections, and practitioner presentations.
• Uses an explicit self-regulatory framework:
• Framework includes principles of self-sufficiency, self-efficacy, self-management, and problem-solving.
• Parents are taught how to monitor their own and their child's behavior, and asked to set specific and observable goals for change.
• Self-management and self-sufficiency are enhanced by having the practitioner prompt the parents to review their application of new parenting strategies, reflecting on what they did well in the process (their strengths), and then setting specific goals for any difficulties or challenges they experienced.
• Parents are assisted in applying the principles they have learned to solve problems in a self-sufficient manner that leads to more independence.
• Practitioners are encouraged to use multiple, relevant examples with families and to create a flexible teaching environment.
• Uses the principles of minimal sufficiency to ensure cost effectiveness:
• System Triple P allows tailoring of intervention intensity to meet individual family needs which helps cost effectiveness.
• Practitioners assess the level of risk the family faces via an intake interview, questionnaires, monitoring, and observation of parent-child interaction.
• Practitioners tailor the level of intensity based on the level of risk and difficulty the family faces (i.e., the higher the risk, the higher the intensity).
• Practitioners administer assessments after completion of an intervention level to determine if a family needs additional levels of intervention.
• Incorporates identifiable program elements to promote generalization and transfer of learning:
• System Triple P provides multiple examples as part of its flexible training philosophy.
• System Triple P teaches generalization and maintenance across time, situations, and children.
• Practitioners teach parents strategies for managing high-risk situations (e.g., going shopping) to ensure generalization across contexts.
• Offers and evaluates flexible delivery modalities such as:
• Media-based delivery (e.g., television series, radio public service messaging, and newsletters) - Level 1
• Group delivery (large and small groups; single meeting group for one behavior or multiple meeting group for broad-based skill development)
• Selected Seminars - Level 2: Seminars can accommodate a small to large number of parents (10 to 100s).
• Discussion Group - Level 3: Discussion groups can accommodate, on average, 10 parents.
• Targeted Behavior Interventions - Levels 4 and 5: Groups of families (up to 12 parents) or individual families.
• Individual delivery – Levels 4 and 5 primarily
• Levels 2-5 may be offered in a variety of settings (e.g., home, clinic, school, family resource center)

Program Delivery

Parent/Caregiver Services

Triple P - Positive Parenting Program® System (System Triple P) directly provides services to parents/caregivers and addresses the following:

• Management of child behavior problems, management of stress, mild-moderate depression symptoms, anxiety, anger, parenting partner conflict, and negative attributional thinking

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: In System Triple P, the parent(s) and/or caregivers are the main participants; other family members may be asked to join if it fits into the family's parenting plan. The intention is to empower parents or caregivers to raise children and to become increasingly self-reliant. Children can be involved in the initial phases of intervention for assessment via interview and/or observation. Children are also involved for parent-child interaction observation later in the program.

Recommended Intensity:

Level 1 - Universal/Stay Positive which has variable outreach strategies (websites, parent newspaper, brochures, posters, and radio/TV spots) that are planned to reach the entire population at planned intervals. ----- Level 2 - Selected Seminars/Selected Seminars Teen which has 3 two-hour long seminars that may be offered as standalone events or together in a series and brief primary care which has 1-2 brief consultations up to 30 minutes in duration. ----- Level 3 - Primary Care/Primary Care Teen/Primary Care Stepping Stones which has 1-4 brief consultations that are approximately 30 minutes in duration and 4 two-hour long discussion groups that may be offered as standalone events or together in a series. ----- Level 4 - This level can consist of a variety of options: 1) Group/Group Teen/Group Stepping Stones which has 5 two-hour group sessions and 3 twenty-minute individual telephone consultations for each family offered over 8 consecutive weeks; 2) Triple P Online which has 8 self-paced online modules; 3) A self-directed workbook which is self-paced; or 4) Standard/Standard Teen/Standard Stepping Stones which are 10 one-hour sessions that occur weekly. ----- Level 5 - This level can consist of a variety of options: 1) Enhanced which has 3-10 sessions lasting 60-90 minutes each; 2) Pathways which has 4 sessions lasting 60-90 minutes each when offered individually or two hours each when offered as a group; 3) Family Transitions which has 10 two-hour group sessions with 2 individual telephone consultations for each family lasting 30 minutes; or 4) Group Lifestyle which has 10 90-minute groups with 4 individual telephone consultations for each family lasting 30 minutes.

Recommended Duration:

Level 1 Universal Triple P may be planned for intermittent distribution of materials throughout the course of the Level 2-5 interventions. Stay Positive is typically planned as a three-year implementation. ----- Levels 2-3 interventions may include 1-4 encounters that take place over 1-6 weeks. ----- Level 4-5 interventions typically take place over 2-4 months. If accommodations are needed (e.g., low literacy clients), the duration may be longer.

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster / Kinship Care
• Hospital
• Outpatient Clinic
• Community-based Agency / Organization / Provider
• Group or Residential Care
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Triple P - Positive Parenting Program® System (System Triple P) includes a homework component:

Homework is an integral part of System Triple P and is agreed upon in session and reviewed in the following visit as part of the parent learning to self-regulate. Homework could include monitoring of parent behavior, implementation of positive parenting strategies (e.g., behavior charts) and discipline routines, practice sessions with child, viewing videos, reading parent workbooks, problem-solving exercises, and planned discussion with parenting partner.

Languages

Triple P - Positive Parenting Program® System (System Triple P) has materials available in languages other than English:

Arabic, Berber, Chinese, Danish, Dutch, Flemish, French, German, Greek, Indonesian, Japanese, Malay, Papiamentu, Portuguese, Romanian, Spanish, Swedish, Turkish, Urdu, Vietnamese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

For individual families, practitioners will need the accompanying parent resources for a given intervention and a space to talk with the parent that is comfortable for the parent (e.g. appropriate level of privacy, etc.). These practitioners will also need equipment to show families DVD clips (e.g., laptop with a DVD, portable DVD player, TV with DVD, etc.). For group interventions, practitioners will need A/V equipment to deliver a PowerPoint presentation as well as show DVD clips to parents. Practitioners will also need a white board or flip chart. Level 2-5 interventions require a single practitioner/consultant to provide the direct service. However, it is highly recommended that agencies staff their System Triple P program in order to sustain it. For even the smallest implementations, 4 practitioners are recommended.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

System Triple P provider training courses are usually offered to practitioners with a post-high school degree in health, education, child care, or social services. In exceptional circumstances, this requirement is relaxed when the prospective practitioners are actively involved in "hands-on" roles dealing with the targeted parents, children, and teenagers. These particular practitioners have developed, through their workplace experience, some knowledge of child/adolescent development and/or have experience working with families.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

• Triple P America
  www.triplep.net
  contact.us@triplep.net
  phone: (803) 451-2278
  fax: (803) 451-2277

Training Type/Location:

Most commonly training is provided onsite with an agency or organization hosting the training. However, Triple P also hosts and provides trainings in an Open Enrollment format several times a year for agencies and organizations that do not have a large enough group for an agency-based training. Open Enrollment trainings are conducted in major cities around the U.S., depending on regional demand, and will be posted on the Triple P website.

Number of days/hours:

Depending on the specific training(s), the number of days can be between 2-5 days, plus 1 full-day of Pre-Accreditation following training, and a 1/2 day accreditation (per trainee) held 6-8 weeks post-training. Training and Pre-Accreditation cohorts are comprised of 20 trainees with one Triple P trainer. These cohorts are divided into smaller groups during the final accreditation procedures. The actual training hours for each training day are 9:00 am - 4:30 pm, including two 20-minute breaks and a 45-minute lunch break, most often catered onsite by the hosting agency.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Triple P - Positive Parenting Program® System (System Triple P) as listed below:

Support using the Implementation Framework is inclusive of several tools designed to support agencies in the successful adoption of Triple P. Examples of these documents include:

• Organizational Readiness Checklist for Implementing Triple P — a brief self-assessment that focuses on key implementation milestones and assists organization(s) in identifying areas of strength and areas requiring more development.
• Implementation Milestones Checklist — a list that details the key milestones involved throughout the phases of implementation and can serve as a guide for an organization as they plan and begin implementing Triple P.
• Self-Assessment Implementation Drivers Checklists — tools that are designed to assist a local implementation team in assessing the current state of implementation drivers and determining if any changes will be required for the program being implemented:
• Coaching and Peer Support
• Facilitative Administrative Supports
• Leadership
• Performance Management
• Recruitment and Selection
• System Intervention
• Training and Accreditation

The Triple P Implementation Tools are provided with support from an Implementation Consultant at no cost for agencies planning to adopt Triple P. Please email contact.us@triplep.net for more information related to the Triple P Implementation Framework

Formal Support for Implementation

There is formal support available for implementation of Triple P - Positive Parenting Program® System (System Triple P) as listed below:

Triple P America utilizes the Triple P Implementation Framework. The Framework is flexible and follows the key principles of Triple P — self-regulation and minimal sufficiency (i.e., it is a guiding framework for support of those implementing Triple P and the level of support may be decreased or increased to match the needs and available resources for a given agency or community.) For this reason, the Framework supports the full range of potential implementation possibilities from small, single organization implementations to complex multi-sector public health applications.

Triple P America employs Implementation Consultants who are available from point of interest through the implementation process, providing technical support, coaching, and consultation. This includes supporting organizations in the implementation planning process and sharing of Triple P implementation tools is included for agencies/jurisdictions adopting Triple P. For complex initiatives, organizations without experience in implementing manualized practices, or organizations without the capacity to support multi-organizational implementation, Triple P America can provide additional implementation support at an additional cost.

Fidelity Measures

There are fidelity measures for Triple P - Positive Parenting Program® System (System Triple P) as listed below:

Triple P has three quality assurance/fidelity checks built into its implementation framework:

1. Session Checklists — Each intervention has a session checklist which assists practitioners in implementing the service as intended. Organizations have the flexibility to utilize these instruments as self-assessments or in more formal quality assurance procedures. These can be provided for agencies interested in adopting Triple P.
2. Accreditation of Practitioners — Completed within the context of a Triple P Provider Training Course, this establishes baseline competence of all practitioners and certifies them as being able to implement the program as intended. The accreditation process has two steps: obtaining a passing score on a written exam and displaying competence in parent consultation skills as scored by an accredited Triple P trainer through direct observation or DVD submission. Procedures are in place to help and "recycle" practitioners to master the intervention when they do not pass accreditation.
3. Peer Support Networks - A crucial element in implementation sites involves the adoption of a self-regulatory framework and the use of the Peer Assisted Support and Supervision (PASS) model of quality assurance. During PASS sessions, practitioners are expected to present cases, obtain feedback from other qualified practitioners, and continue to supplement their skills with continuing education. The PASS manual and checklist are available to trained practitioners through the Triple P Provider Network.

Other quality assurance and fidelity checks are possible to implement and Triple P America implementation consultants will work with local agencies to craft a plan that is consistent with local oversight agency procedures. Please email contact.us@triplep.net for further information on measures of fidelity.

Implementation Guides or Manuals

There are implementation guides or manuals for Triple P - Positive Parenting Program® System (System Triple P) as listed below:

Triple P has two levels of implementation tools available. Implementation Consultants can provide support to organizations to develop their own handbook of implementing Triple P, using the tools and processes in the Implementation Framework to provide a context specific guide for those responsible for coordinating the implementation of Triple P at that organization or region. For agencies, the Triple P Implementation Workbook serves as a primer and guide on the implementation process. For the direct service provider, each level of Triple P includes a Practitioner Manual with step-by-step guidelines for successful delivery of Triple P.

Tools associated with the Implementation Framework are provided in conjunction with support from a Triple P Implementation Consultant for agencies or jurisdictions interested in adopting Triple P. The Triple P Practitioner Manuals are provided as part of the Triple P training. Please email contact.us@triplep.net from more information related to the Triple P Implementation Framework. The relevant Triple P Practitioner Manual is provided to practitioners when they attend a Triple P Provider Training Course.

Research on How to Implement the Program

Research has been conducted on how to implement Triple P - Positive Parenting Program® System (System Triple P) as listed below:

• Seng, A. C., Prinz, R. J., & Sanders, M. R. (2006). The role of training variables in effective dissemination of evidence-based parenting interventions. The International Journal of Mental Health Promotion, 8(4), 20–28. https://doi.org/10.1080/14623730.2006.9721748
• Sanders, M. R., Prinz, R. J., & Shapiro, C. J. (2009). Predicting utilization of evidence-based parenting interventions with organizational, service-provider and client variables. Administration and Policy in Mental Health and Mental Health Services Research, 36(2), 133–143. https://doi.org/10.1007/s10488-009-0205-3
• Mazzucchelli, T. G. & Sanders, M. R. (2010). Facilitating practitioner flexibility within evidence-based practice: Lessons from a system of parenting support. Clinical Psychology: Science and Practice, 17(3), 238–252. https://doi.org/10.1111/j.1468-2850.2010.01215.x
• Turner, K. M. T., Nicholson, J. M., & Sanders, M. R. (2011). The role of practitioner self-efficacy, training, program and workplace factors on the implementation of an evidence-based parenting intervention in primary care. Journal of Primary Prevention, 32(2), 95–112. https://doi.org/10.1007/s10935-011-0240-1
• Breitkreuz, R., McConnell, D., Savage, A., & Hamilton, A. (2011). Integrating Triple P into existing family support services: A case study on program implementation. Prevention Science, 12(4), 411–422. https://doi.org/10.1007/s11121-011-0233-6
• Asgary-Eden, V., & Lee, C. M. (2012). Implementing an evidence-based parenting program in community agencies: What helps and what gets in the way? Administration and Policy in Mental Health and Mental Health Services Research, 39(6), 478–488. https://doi.org/10.1007/s10488-011-0371-y
• Shapiro, C. J., Prinz, R. J., & Sanders, M. R. (2012). Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment the Triple P-Positive Parenting Program. Child Maltreatment, 17(1), 86–95. https://doi.org/10.1177/1077559511424774
• Fives, A., Pursell, L., Heary, C., Nic Gabhainn, S., & Canavan, J. (2014). Parenting support for every parent: A population-level evaluation of Triple P in Longford Westmeath. Final report. Longford Westmeath Parenting Partnership. http://www.childandfamilyresearch.ie/media/unescochildandfamilyresearchcentre/documentspdf/parenting_support_for_every_parent_-_final_report_june_2014-(Triple-P).pdf
• Romney, S., Israel, N., & Zlatevski, D. (2014). Exploration-stage implementation variation: Its effect on the cost-effectiveness of an evidence-based parenting program. Zeitschrift für Psychologie, 222(1), 37–48. https://doi.org/10.1027/2151-2604/a000164
• Sanders, M., & Burke, K. (2014). The "hidden" technology of effective parent consultation: A guided participation model for promoting change in families. Journal of Child and Family Studies, 23(7), 1289–1297. https://doi.org/10.1007/s10826-013-9827-x
• Shapiro, C. J., Prinz, R. J., & Sanders, M. R. (2015). Sustaining use of an evidence-based parenting intervention: Practitioner perspectives. Journal of Child and Family Studies, 24, 1615–1624. https://doi.org/10.1007/s10826-014-9965-9
• Aldridge, W. A., II, Murray, D. W., Prinz, R. J., & Veazey, C. A. (2016). Final report and recommendations: The Triple P implementation evaluation, Cabarrus and Mecklenburg counties, NC. Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill. https://fpg.unc.edu/sites/fpg.unc.edu/files/resource-files/TPIE%20Final%20Report_Jan2016.pdf
• McWilliam, J., Brown, J., Sanders, M. R., & Jones, L.(2016). The Triple P implementation framework: The role of purveyors in the implementation and sustainability of evidence-based programs. Prevention Science, 17, 636–645. https://doi.org/10.1007/s11121-016-0661-4

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety, Permanency and Child/Family Well-Being

Additional References