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Promising Program Seal

Triple P System

Blueprints Program Rating: Promising

A public health approach to reach all parents in a community to enhance parental competence and prevent or alter dysfunctional parenting practices, thereby reducing family risk factors both for child maltreatment and for children's behavioral and emotional problems.

Program Outcomes

  • Child Maltreatment
  • Mental Health - Other

Program Type

  • Parent Training

Program Setting

  • Community (e.g., religious, recreation)
  • Home
  • Hospital/Medical Center
  • Mental Health/Treatment Center
  • School

Continuum of Intervention

  • Universal Prevention (Entire Population)
  • Selective Prevention (Elevated Risk)

Age

  • Infant (0-2)
  • Early Childhood (3-4) - Preschool
  • Late Childhood (5-11) - K/Elementary
  • Adult

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Blueprints: Promising
  • Coalition for Evidence-Based Policy: Near Top Tier
  • Crime Solutions: Effective
  • OJJDP Model Programs: Effective

Program Information Contact

Triple P America 
E-mail: contact.us@triplep.net
Phone: (803) 451-2278
Web: www.triplep.net/glo-en/home/

Program Developer/Owner

  • Matthew Sanders, Ph.D.
  • The University of Queensland

Brief Description of the Program

The Triple P Positive Parenting Program is designed as a comprehensive population-level system of parenting and family support for famlies having at least one child in the birth to 12-year-old range. The multilevel system includes five intervention levels of increasing intensity and narrowing population reach. The system is designed to enhance parental competence and prevent or alter dysfunctional parenting practices, thereby reducing an important set of family risk factors, both for child maltreatment and for children's behavioral and emotional problems. In the Triple P system, a media and communication strategy is utilized extensively in a sophisticated and strategic manner to normalize and acknowledge the difficulties of parenting experiences, to break down parental sense of social isolation regarding parenting, to de-stigmatize getting help, to impart parenting information directly to parents, and to alter the community context for parenting.

In a population level version of Triple P, the existing workforce crossing several disciplines and settings (such as family and social support services, preschool/child-care settings, elementary schools, and other community entities with direct contact with families) is trained to deliver the Triple P system of interventions. They in turn deliver Triple P to parents in 1-10 or more sessions tailored to the severity of the family's dysfunction and/or child's behavioral problems.

See: Full Description

Outcomes

U.S. Population Study:

  • Positive effects in the Triple P System counties for rates of substantiated child maltreatment, child out-of-home placements, and hospitalizations or emergency-room visits for child maltreatment injuries, compared to Control counties.

Australia Population Study:

  • Triple P System was associated with significantly greater reductions in emotional problems and psychosocial distress in both children and their parents than in the care as usual condition.
  • No intervention effects were found for conduct problems, hyperactivity and peer relationship difficulties.

Significant Program Effects on Risk and Protective Factors:

  • Greater reduction in coercive parenting was found in TPS vs. CAU conditions (Australian Study).

Risk and Protective Factors

Risk Factors
  • Family: Family conflict/violence*, Parent stress*, Poor family management, Psychological aggression/discipline*, Violent discipline*
Protective Factors
  • Individual: Coping Skills
  • Family: Attachment to parents, Non-violent discipline*, Parent social support

*Risk/Protective Factor was significantly impacted by the program.

See also: Triple P System Logic Model (PDF)

Training and Technical Assistance

Level 2: Selected Triple P:

The minimum qualification level for the lead practitioner of Level 2 Selected Triple P is QCF Level 4/5 (Certificate C Level/Intermediate I Level) and the recommended qualification level is QCG Level 6 (Honours H Level).

Lead practitioners of Level 2 Seminar Triple P are expected to have some knowledge of child development, the impact parenting can have on children, and some experience working with families.

Training is provided by accredited Triple P Trainers in intensive face-to-face workshop of 1-day training (7.5 hours) and then half a day accreditation. There is no accreditation quiz. The practitioner must have been trained and accredited in either a Level 3 or Level 4 Triple P program as a prerequisite before beginning Level 2 Selected training.

Training

Attend a Selected Triple P Provider Training Course.

Triple P is designed for use by a variety of health, education and welfare professionals who consult with parents about children’s behavior and development. It is assumed that practitioners using Triple P will have a basic professional qualification in either psychology, psychiatry, pediatrics, medicine, nursing, special education, social work or counseling. Practitioners delivering the Triple P Seminar Series should have a good working knowledge of child development, be familiar with major types of child psychopathology, and have skills in the application of social learning principles to child behavior and emotional problems.

To be accredited as a Selected Triple P provider, completion of a structured Triple P accreditation process is required. For information about Triple P practitioner training visit the Triple P website (www.triplep.net). For information about the Triple P Practitioner Network for accredited practitioners visit www.triplep.org.

Practitioners interested in completing Triple P training to deliver the Triple P Seminar Series can complete the following:

  • Training for Selected Triple P provides an introduction to the field of behavioral family intervention and information on the application of positive parenting strategies to a variety of child behavioral and emotional problems.
  • To become a formally accredited Triple P provider, completion of a structured Triple P accreditation process is required.

Level 3: Primary Care Triple P:

The minimum qualification level for the lead practitioner of Primary Care Triple P is QCF Level 4/5 (Certificate C Level/Intermediate I Level) and the recommended qualification level is QCG Level 6 (Honours H Level).

Lead practitioners of Primary Care Triple P are expected to have some knowledge of child development, the impact parenting can have on children, and some experience working with families.

Training is provided by accredited Triple P Trainers in intensive face-to-face workshops of 2 days duration followed by a one-day accreditation.

Training

Attend a Primary Care Triple P Provider Training Course.

A full Primary Care Triple P Provider Training Course consists of two parts. The first part consists of attending a Level 3 Primary Care Triple P Provider Training Course 2 x 7.5 hour days of workshops. The second part involves a day of accreditation. This course provides a specific focus on process issues and practical implementation of Primary Care Triple P. For facilitators who have already completed Group Triple P, the Primary Care Triple P course can be taken as a one-day extension course with an additional day for accreditation.

Following completion of the Primary Care Triple P components, participants will have acquired advanced skills in the following additional areas:

  • Demonstrated proficiency in conducting Primary Care Triple P.
  • Be able to explain, model and answer questions relating to the core positive parenting strategies.
  • Be able to assist a parent to a set specific, actionable, age-appropriate behavior change goals for their children.
  • Demonstrated skills for completing effective practice sessions.
  • Shown in-depth knowledge and understanding of strategies necessary for enhancing generalization and maintenance of program effects.
  • Demonstrated knowledge of how to deal with process issues such as difficult parent questions and parental resistance.
  • Demonstrated knowledge and understanding of indicators that suggest more intensive intervention is required.

Accreditation involves practitioners passing a multiple-choice exam and displaying a set of core competencies in a face-to-face small group accreditation session. Peer support groups and pre-accreditation workshops provide practitioners with a means to practice before the accreditation session is attended.

Level 4: Group and Standard Triple P:

The minimum qualification level for the lead practitioner of Group and Standard Triple P is QCF Level 4/5 (Certificate C Level/Intermediate I Level) and the recommended qualification level is QCG Level 6 (Honours H Level).

Lead practitioners of Group and Standard Triple P are expected to have some knowledge of child development, the impact parenting can have on children, and some experience working with families.

Training is provided by accredited Triple P Trainers in intensive face-to-face workshops of 3 days duration followed by a one-day accreditation.

Training

Attend training sessions (typically consists of 3 x 7.5 hour days of workshops, but does depend on the combination of training courses the practitioner attends).

Training for Standard or Group Triple P provides an introduction to the field of behavioral family intervention and detailed information on the application of positive parenting strategies to a variety of child behavior problems. Following completion of Group Triple P training, participants have enhanced knowledge and skills in the following areas:

  • Use of questionnaires to assess child and family functioning.
  • Strategies for promoting generalization and maintenance of behavior change.
  • Use of active skills training in a group format.
  • Managing group dynamics and common process issues.
  • Conducting telephone consultations with parents.
  • Identification of indicators suggesting more intensive intervention is required.
  • Appropriate referral procedures.

The onus is on the practitioner to complete background reading and professional skills development in this area. To become a formally accredited Triple P provider, completion of a structured Triple P accreditation process is required.

Accreditation involves practitioners passing a multiple-choice exam and displaying a set of core competencies in a face-to-face small group accreditation session. Peer support groups and pre-accreditation workshops provide practitioners with a means to practice before the accreditation session is attended.

Level 5: Enhanced Triple P:

The minimum qualification level for the lead practitioner of Enhanced Triple P is QCF Level 4/5 (Certificate C Level/Intermediate I Level) and the recommended qualification level is QCG Level 6 (Honours H Level).

Lead practitioners delivering Level 5 Enhanced interventions should have sound knowledge of child development and psychopathology, have skills in the application of social learning principles to child behavior problems, and have experience in the use of cognitive behavioral techniques in individual and couples programs for adults.

Training is provided by accredited Triple P Trainers in intensive face-to-face workshops of a minimum of 2 days duration (depending on the facilitators' prior training), and this is followed by a half day accreditation.

Training

Attend a Level 5 Enhanced Triple P Provider Training Course.

Attend training sessions (typically consists of 2 x 7.5 hour days of workshops and a half-day accreditation). However, practitioners must have completed Group or Standard Triple P prior to completing this training. This can be accomplished separately or over five consecutive days of training, plus two half days of accreditation.

Accreditation involves practitioners passing a multiple-choice exam and displaying a set of core competencies in a face-to-face small group accreditation session. Peer support groups and pre-accreditation workshops provide practitioners with a means to practice before the accreditation session is attended.

Stepping Stones Triple P: Standard:

The minimum qualification level for the lead practitioner of Stepping Stones Triple P is QCF Level 4/5 (Certificate C Level/Intermediate I Level) and the recommended qualification level is QCG Level 6 (Honours H Level).

Lead practitioners delivering Stepping Stones Triple P interventions should have sound knowledge of child development and psychopathology, have skills in the application of social learning principles to child behavior problems, and have experience in the use of cognitive behavioral techniques in individual and couples programs for adults.

Training is provided by accredited Triple P Trainers in intensive face-to-face workshops of 3 days duration (depending on the practitioner’s prior training), and this is followed by a half day accreditation.

Training

Training in Standard Stepping Stones Triple P consists of 3 x 7.5 hour day workshops.

Training for Standard Stepping Stones Triple P provides an introduction to the field of behavioral family intervention and detailed information on the application of positive parenting strategies to a variety of developmental issues for parents of a child with a disability. Following completion of the training, participants have enhanced knowledge and skills in the following areas:

  • Use of questionnaires to assess child and family functioning.
  • Strategies for promoting generalization and maintenance of behavior change.
  • Use of active skills training.
  • Managing common process issues.
  • Identification of indicators suggesting more intensive intervention is required.
  • Appropriate referral procedures.

Accreditation involves practitioners passing a multiple-choice exam and displaying a set of core competencies in a face-to-face small group accreditation session. Peer support groups and pre-accreditation workshops provide practitioners with a means to practice before the accreditation session is attended.

All Levels:

Supervision

Triple P adopts a unique peer support self-regulation approach to supervision. The aim is to promote reflective practice and tailoring of the intervention to the needs of parents, while maintaining fidelity to the intervention model. It involves practitioners meeting regularly to discuss cases and issues arising from the delivery of the program. It is ideal for practitioners to make a video or audio recording of their program delivery and review this during supervision with small groups of peers. This small group format provides a forum for self-evaluation and peer feedback to enhance and maintain clinical skills and program integrity. When Triple P is used as part of a clinical service, provision should be made to ensure some supervision is available to practitioners using the program. Regular supervision can help reduce burnout and lead to more competent service delivery.

Technical Assistance

Triple P has an exclusive technical and consultation support process that can be accessed by trained and accredited providers through the Triple P Practitioner Network (www.triplep.org). There are also implementation guidelines for agencies wishing to implement Triple P, manager briefings, and an annual Triple P Conference (Helping Families Change Conference - www.helpingfamilieschange.com).

For information on Triple P training and accreditation contact: Triple P America, Inc., PO Box 12755, Columbia, SC 29211. Tel: (803) 451 2278 Email: contact.us@triplep.net Website: www.triplep.net.

Training Certification Process

Training Trainers

Triple P Trainers are masters- or doctorate-level professionals (mainly clinical or educational psychologists) who are recruited and trained to train practitioners (Triple P providers) to implement Triple P programs with the parents with whom they work.

Professionals invited to become Triple P trainers undergo an intensive two-week training program. After initial induction, trainers are provisionally accredited and can begin conducting training under supervision from TPI. To be considered fully trained, trainers have to complete a skills-based accreditation process. Trainers do not work independently and use standardized materials, which serves to ensure that program integrity is protected. Although many agencies favor a train-the-trainer model, such an approach can lead to substantial program drift and poorer client outcomes. Program disseminators can quickly lose control of the training process and, as a result, can find it harder to efficiently incorporate revisions and changes when ongoing research indicates they are required. Maintaining control over the initial training of providers, although not without its challenges (when the demand for a program occurs in different cultural contexts), is achievable and helps to promote quality standards.

Maintaining Training Quality

To prevent program drift, all Triple P Trainers use standardized materials (including participant notes, training exercises, and training DVDs demonstrating core consultation skills) and adhere to a quality-assurance process; trainers become part of a trainer network, and maintenance of their accreditation is required by the completion of professional development activities over designated 2-year periods. Triple P International manages all aspects of the training program, including the initial training, post-training support, and follow-up technical assistance.

Technical and Consultation Support

The Triple P team encourages organizations and practitioners to access ongoing back-up consultative advice post training. Triple P staff members have ongoing email contact, teleconferences, and staff meetings as well as update days to address administrative issues (e.g., data management, performance indicators), logistical issues (e.g., avoidance of accreditation workshops due to anxiety, referral strategies), and clinical issues (e.g., dealing with specific populations, clinical process problems) identified by practitioners. These contacts actively engage agency staff in troubleshooting. An online practitioner network has also been established to provide ongoing technical support to practitioners using Triple P (http://www.triplep.org). This network provides practitioners with downloadable clinical tools and resources (e.g., monitoring forms, public domain questionnaires, and session checklists), updates of new research findings, and practice tips and suggestions. An international practitioner network for accredited providers enables Triple P practitioners to keep up to date with the latest developments in the world of Triple P, including recent research findings and new programs being released.

Encouraging Reflective Practice through Supervision

Practitioners who access supervision and workplace support post-training are more likely to implement Triple P. A self-regulatory peer-assisted approach is the preferred method of supervision in the dissemination of Triple P (see Sanders & Murphy-Brennan, 2010a, Sanders et al. 2002, Turner et al., 2011). The self-regulation approach to supervision is an alternative to more traditional, hierarchically based group or individual clinical supervision with an experienced, expert supervisor who provides mentoring, feedback, and advice. The self-regulation model utilizes the power and influence of the peer group to promote reciprocal learning outcomes for all participants in supervision groups. Under this model, peers become attuned to assessing the clinical skills of fellow practitioners and provide a motivational context to enable peer colleagues to change their own behaviors, cognitions, and emotions so they become proficient in delivering interventions.

Brief Evaluation Methodology

The population trial randomized geographical units to condition, matching on demographic and child-abuse variables, and evaluated the impact of implementing Triple P with the existing workforce on population indicators related to child maltreatment. This trial targeted rates and aggregate dimensions for entire geographic areas to study broad impact. The U.S. Triple P System Population Trial consisted of the stratified random assignment of 18 medium-sized counties in a southeastern state to dissemination and control conditions, controlling for county population size, county poverty rate, and county child abuse rate. Evaluation was done after the 2-year period of intervention dissemination.

Peer Implementation Sites

Nicole Young
First 5
Santa Cruz, CA
Email: nicole@opti-solutions.com
Phone: (831) 594-1498
Website: first5scc.org/families-are-strong/triple-p

Barbara Sheppard
Cabarrus Health Alliance
Cabarrus County, NC
Email: Barbara.Sheppard@cabarrushealth.org
Phone: (704) 920-1367
Website: www.cabarrushealth.org/153/Triple-P-Positive-Parenting_Program

References

Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J. & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P System population trial. Prevention Science, 10, 1-12.

Sanders, M. R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S. & Bidwell, K. (2008). Every family: A population approach to reducing behavioral and emotional problems in children making the transition to school. The Journal of Primary Prevention, 29, 197-222.