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Positive Parenting Program (Triple P) - Level 4 Group

Category

Family Support

Child's Age

2-3 years, 3-4 years, 4-5 years

Participant

Parents/Guardian

Languages

English, Spanish, French, Other

Brief Description

Parent education for parents of children with severe behavioral difficulties offered as group sessions. Includes both group sessions and individual counseling via telephone calls.

Expected Impact

  • Improved scores on PS, ECBI, DASS, and ADAS
  • Increase in positive discipline behaviors immediately, postintervention, and during follow-ups over the course of up to 10 years
  • Reduction in dysfunctional parenting
  • Improved child well-being
  • Reduced externalizing behaviors 
  • Increase in positive engagement behaviors

Core Components for Model Fidelity

  • Group Sessions: Up to 12 parents attend 5 group sessions. 
    • Session 1: Positive Parenting
    • Session 2: Helping Children Develop
    • Session 3: Managing Misbehavior
    • Session 4: Planning Ahead
    • Session 5-7: Using Positive Parenting Strategies 1-3
    • Session 8: Program Close 
  • Workbook: Each family receives a copy of Every Parent’s Group Workbook. This workbook provides them with the content of all sessions, space to complete written exercises, and an outline of all homework tasks. 
  • Phone Counseling: Participants receive 3 phone counseling sessions.

Languages Materials are Available in

English, Spanish, French, Other*

*Contact purveyor about additional available languages.

Delivery Mode

In-person group sessions. 

Virtual phone counseling sessions.

Dosage

Minimim of four 2-hour group sessions delivered over 8 weeks with four 20-minute phone counseling sessions delivered between group sessions. May add an additional phone counseling session as needed for a total of five phone counseling sessions.                     

Infrastructure for Implementation

Materials: Facilitator’s Kit for Group Triple P (includes Facilitator’s Manual and Every Parent’s Group Workbook); Access to the Group Triple P PowerPoint presentations; Access to the Every Parent’s Survival Guide video; A copy of Every Parent's Group Workbook for each family in the group.

Space: Adequate meeting space for group sessions, computer projection, and sound for video components if delivered in-person. If delivered virtually, a virtual meeting platform with video streaming capability.

Staffing Requirements

Staffing requires a Group Triple P Accredited practitioner. This practitioner only needs to have a knowledge of child development to be eligible for training; however, given this level of intervention, a history of work and/or education with parenting interventions is beneficial. It is also recommended that staff members have high levels of comfort with small group delivery. Triple P practitioners are not restricted to only the delivery of Triple P. They can implement Triple P alongside other job duties and/or program implementation.

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) for more information, training, and certification. 

Training for Model Fidelity

Practitioners must complete an approved training program and accreditation process through Triple P America. Training is available in-person or through a hybrid option supported by video conference. 

The virtual and in-person options include 3 days of training, 1 pre-accreditation day, and half day of accreditation. Preparation for the accreditation day requires 4-6 hours to prepare for the quiz and competency assessment. It is also strongly recommended that practitioners engage in peer support post training, which can vary in time and/or frequency (usually about 1 hour a month, but may be more frequent at the beginning). 

Contact Information

https://www.triplep.net/glo-en/the-triple-p-system-at-work/the-system-explained/

contact.us@triplep.net
803-451-2278  

Sara van Driel, PhD: Community Engagement/Implementation Consultant at Triple P America; sara@triplep.net

Ashley Lindsay: Community Engagement/Implementation Consultant at Triple P America; ashley.lindsay@triplep.net

Cost Estimates

2023 cost for Level 4 Group virtual Open Enrollment is $2850/person which is inclusive of training, pre-accreditation, practitioner materials, and access to the Triple P Provider Network and Automated Scoring and Reporting Application. The 2023 cost for a virtual agency-based training is $40,400 (which equates to approximately $2020 per person when there are 20 practitioners.) Smart Start local partnerships interested in Triple P training should connect with their local Lead Implementing Agency for North Carolina. If you are unsure of your local contact, please email contacts.us@triplep.net. Further, the 2023 cost for parent materials for Group Triple P is approximately $34/parent. The costs noted here are just for training and parent materials. Other start up costs will depend on the agency and specific practitioner.

Purpose Service Code (PSC)

5505 - Parent Education

Program Identifier (PID)

 Positive Parenting Program (Triple P) - Level 4 Group

Minimal Outputs for NCPC Reporting

  FY 24-25:

  • Number of parent/guardians participating† 

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.

Minimal Outcomes for NCPC Reporting

  FY 24-25:

  • Increase in positive parenting practices

Minimal Measures for NCPC Reporting

  FY 24-25:

  • TRIPLE P CLIENT SATISFACTION QUESTIONNAIRE – Level 4 (Group Standard)
  • TRIPLE P PARENTING SCALE – LEVEL 4

NCPC Evidence Categorization

Evidence Based- Four evaluations, including two randomized control trials and a quasi-experimental study which use comparison groups.

Research Summary

Four of the most relevant publications on Triple P Level 4- Group include a quasi-experimental study,1 two randomized control trials,2 3 and an evaluation that deconstructed the Triple P Group model to compare the outcomes of participants in the traditional model, the model with only 4 group sessions and no phone calls, and a control group.4 Participants primarily included families from small or moderate sized cities in Germany with a child ages 2-6 years. Only one study sampled families from communities with the greatest need (such as population growth rates and rates of child abuse reports higher than the state average). Measures included the Eyberg Child Behavior Inventory (ECBI), Parenting Scale (PS), Depression Anxiety Stress Scales (DASS), Abbreviated Dyadic Adjustment Scale (ADAS), Positive Parenting Questionnaire (PPQ), and Child Behavior Checklist (CBCL), and a Client Satisfaction Questionnaire (CSQ). Results of these studies indicated that Triple P Group participants demonstrated improvements in PS adjusted mean total scores and reported improvements in ECBI adjusted mean scores postintervention. Scores on the DASS declined by 7.2 points postintervention (95% CI = 5.7, 8.7). ADAS scores also improved immediately postintervention (-1.01, 95% CI = -1.4, -0.6). Participants demonstrated an increase in positive discipline behaviors immediately postintervention and during follow-ups over the course of up to 10 years. Participants reported a reduction in dysfunctional parenting, which remained stable from preintervention through the follow-up period. The study comparing Triple P Group with the group sessions and phone consultations (4+4 condition) and a modification with only the group sessions (4 only) found that outcomes for both conditions were very similar, suggesting that the phone consultations are not necessary to see the impacts of Group Triple P.

  1. ^ See Zubrick et al. (2005). This quasi-experimental two-group longitudinal study reports outcomes for children whose parents participated in Triple P Group and a comparison group. The study includes data immediately after completing the program as well as data from the 1-year and 2-year follow-up assessments. The intervention group (N = 804) was based in the Eastern Metropolitan Health Region of Western Australia, which, compared to other metropolitan health regions, has the highest rates of child abuse reports, proportion of families receiving Family Crisis Program benefits, and proportion of preschool aged children. Participants were primarily two-parent "original" families (82.2%) in their first marriage (72.2%). Children were, on average, 43.9 months old and primarily male (58.7%). The study featured a comparison group (N = 806) consisting of parents from the South Metropolitan Health Region. This region's rate of child abuse reports, proportion of families receiving Family Crisis Program benefits, and proportion of preschool aged children are higher than the state average yet lower than the intervention region. There were significant differences between these groups, including child ages (M = 45.6 months, p < 0.0001), proportion from step/blended families (6.3% vs. 4.2%, p < 0.018), parents with no secondary education (45.2% vs. 37.9%, p < 0.015), and lower prevalence of child behavior problems and parent stress, depression, and conflict about child rearing. Measures included background/demographic questionnaires, the Eyberg Child Behavior Inventory (ECBI), Parenting Scale (PS), Parent Problem Checklist (PPC), Abbreviated Dyadic Adjustment Scale (ADAS), Depression Anxiety Stress Scales (DASS), and a Client Satisfaction survey. Assessments were completed preintervention and 9 weeks, 12 months, and 24 months postintervention. The intervention group participated in a 2-hour training workshop in groups of 10 parents representing 8 children. These workshops occurred once a week for four weeks and were followed by a 15-minute phone call each week. Families received the "Every Parent" book, "Every Parent's Workbook for Groups" workbook, and a video resource. Groups were facilitated by 16 trained facilitators recruited from community and child health services in the region. A clinical psychologist served as the case manager. Trainers were paired with an experienced facilitator to deliver the program. On average, parents received 7.8 hours of program exposure (total dose of 9 hours). Immediately postintervention, participants demonstrated improvements in PS adjusted mean total scores (0.624, 95% CI = 0.57, 0.67) as well as the laxness (0.60, 95% CI = 0.53, 0.67), verbosity (0.70, 95% CI = 0.62, 0.78), and overreactivity subscales (0.69, 95% CI = 0.62, 0.76). The intervention group also reported significant improvements in ECBI adjusted mean scores postintervention (22.43, 95% CI = 20.38, 24.48). Scores on the DASS declined by 7.2 points postintervention (95% CI = 5.7, 8.7). ADAS scores also improved immediately postintervention (-1.01, 95% CI = -1.4, -0.6). Scores on ADAS, DASS, PS, and ECBI followed the trend noted immediately postintervention and remained significant, though not as large, at the 12-month and 24-month follow-up. The intervention group was also more likely to remain below the clinical threshold as measured by ECBI. This study is limited by factors such as the inequal matching of comparison groups.
  2. ^ See Kim et al. (2018). This randomized control trial evaluates Group Triple P in a small urban city in Germany. The sample population included 280 parents of children from 17 randomly selected preschools. The intervention group (N = 186) and control group (N = 94) were randomized at the preschool level. The groups were balanced such that the mean child age was 4 years, about half of children were female, mothers were an average age of 35, and half of mothers graduated from high school. Compared to the national population of eligible families, the sample population had a lower monthly income yet higher graduation rates, lower proportions of single mothers, and a higher percentage of mothers working full-time. The intervention group completed 4 weekly training sessions, each lasting 2 hours, and received 4 weekly telephone sessions lasting 15-20 minutes each. Groups were facilitated by five licensed Triple P providers who received weekly supervision. Assessments were completed preintervention, immediately postintervention, annually in the 4 years following the intervention, and 10 years postintervention. Measures included interviews (during home visits or at the local technical university), a German version of the Parenting Scale (Der Erziehungsfragebogen (EFB)), Positive Parenting Questionnaire (PPQ), Youth Self Report derived from Child Behavior Checklist, a generic quality of life survey for children, Kauffman Assessment Battery for Children, and Child Behavior Checklist (CBCL). Immediately following the intervention, participants demonstrated an increase in positive discipline behaviors. At 3 years postintervention, results indicated a significant increase in positive engagement behaviors. Non-significant findings included positive effects on internalizing behaviors and quality of life, and child subjective well-being. Girls benefitted more from the intervention, demonstrated by larger effect sizes, some of which reached statistical significance, compared to those of boys whose parents participated in the intervention. At the 10-year follow-up, the intervention group continued to report improved child well-being and reduced externalizing behaviors. The study is limited by low statistical power and high rates of false positives.
  3. ^ See Heinrichs et al (2013). This randomized control trial evaluated the impacts of Triple P Group on parenting and child behavior problems over 4 years. Participants included 280 families in a moderate-sized urban city in Germany with a child ages 2.6 to 6 years. The study utilized stratified randomization to assign each of the 17 enrolled preschools to an intervention (N = 11) or control group (N = 6). There were slightly more boys than girls (51%) and the average child age was 4.5 years. Most families were German and two-parent households. The control group had a higher proportion of single mothers (34% vs. 15.6%, p < 0.001). Families received reimbursement for completing assessments. Assessments were conducted at preintervention, immediately postintervention, and annually in the 4 years after the intervention. Measures included Parenting Scale (PS), Positive Parenting Questionnaire (PPQ), and Child Behavior Checklist (CBCL). The intervention group completed four group sessions, each lasting 2 hours. They were offered four weekly individual phone calls with a Triple P facilitator. Five licensed Triple P providers facilitated group sessions and received supervision during weekly staff meetings. Preintervention assessments indicated that parents of girls reported more positive parenting behaviors and fewer child behavior problems. Compared with their peers in the control group, parents in the intervention group reported slightly more child behavior problems. Over the course of the intervention, parents (especially mothers) in the intervention group reported decrease child problem behavior scores, measured by the CBCL. There were no clear differences between the intervention and control groups during follow-up. Additionally, the intervention group reported a reduction in dysfunctional parenting, which remained stable from preintervention through the follow-up period. Mothers in the intervention group reported a lower decline in positive parenting practices from preintervention to postintervention compared to mothers in the control group and fathers. During the follow-up period, all parents reported a decline in positive parenting practices. However, fathers in the intervention group showed a lower decline in positive parenting practices during follow-up. Results also indicated a significant association between changes in dysfunctional parenting (r = 0.18, p = 0.006) and changes in child problem behaviors (r = 0.20, p = 0.009). Limitations to the study include the overall low levels of problem behaviors in the sample and lack of stratification for single-parent status in randomization.
  4. ^ See Gallart & Matthey (2005). This evaluation compared the effects of three conditions: traditional Group Triple P (4 group sessions and 4 telephone consultations - 4+4 condition), modified Group Triple P (4 group sessions only - 4 only condition), and a waitlist control. Participants included 49 parents with a child ages 2 to 8 years. Most participants were mothers (N = 46), had not completed high school (75%), and primarily spoke English (56%). Most children were boys (75%), scored above the clinical cutoff on at least one measure used in the study, and had an average age of 5.4 years. The intervention was facilitated by two trained, accredited psychologists. Participants were randomly assigned to one of the three conditions (4+4, N = 16; 4 only, N = 17; control, N = 16). Assessments were completed preintervention and postintervention (8 weeks later). The researchers attempted to collect 6-month follow-up data but return rates were so poor that there was not enough data to include in the report. Measures included the Eyberg Child Behavior Inventory (ECBI), Parenting Scale (PS), Depression Anxiety Stress Scales (DASS), and a Client Satisfaction Questionnaire (CSQ). Results indicated significant main effects on the Depression (p < 0.05), Anxiety (p < 0.05), and Stress subscales (p < 0.05) of the DASS as well as the ECBI Intensity scale (p < 0.05). Participants in the 4 only and 4+4 treatment conditions demonstrated clinically significant improvements in their scores on at least one DASS subscale (p < 0.01 and p < 0.01, respectively). The intervention groups showed similar improvements on their ECBI scores as well. The outcomes for the 4+4 condition and 4 only condition were very similar, suggesting that the phone consultations are not necessary to see the impacts of Group Triple P.

Researched Population

  • Parents with a child ages 2 to 8 years
  • Primarily mothers
  • Participants who had varying levels of education
  • Primarily English speakers 
  • Children who scored above the clinical cutoff on at least one measure used in the research
  • Mostly families from Germany or Australia

Gallart, S. C., & Matthey, S. (2005). The effectiveness of Group Triple P and the impact of the four telephone contacts. Behaviour Change, 22(2), 71-80. https://doi.org/10.1375/bech.2005.22.2.71

Heinrichs, N., Kliem, S., & Hahlweg, K. (2013). Four-year follow-up of a randomized controlled trial of Triple P Group for parent and child outcomes. Prevention Science, 15, 233-245. http://doi.org/10.1007/s11121-012-0358-2

Kim. J. H., Schulz, W., Zimmerman, T., & Hahlweg, K. (2018). Parent-child interactions and child outcomes: Evidence from randomized intervention. Labour Economics, 54, 152-171. https://doi.org/10.1016/j.labeco.2018.08.003

Level 4 – Triple P. (n.d.). https://www.triplep.net/glo-en/the-triple-p-system-at-work/the-system-explained/level-4/

Zubrick, S. R., Ward, K. A., Silburn, S. R., Lawrence, D., Williams, A. A., Blair, E., Robertson, D., & Sanders, M. R. (2005). Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prevention Science, 6(4), 287-304. https://doi.org/10.1007/s11121-005-0013-2



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Positive Parenting Program (Triple P) - Level 4 Group. Local Partnership contact information can be found here.