Positive Parenting Program (Triple P) - Level 4 Self-Directed
Category
Family Support
Child's Age
2-3 years, 3-4 years, 4-5 years
Participant
Parents/Guardian
Languages
English
Brief Description
Self-help program for parents/caregivers of children with severe behavioral difficulties. Based on a workbook and optional brief weekly telephone consultations for caregivers who need additional support.
Expected Impact
- Reduction in negative or disruptive child behaviors
- Greater parenting competence, satisfaction, and efficacy compared to the waitlist group
- More likely to move from the clinical to non-clinical range on negative child behaviors compared to the waitlist group
Core Components for Model Fidelity
- Self-Paced Curriculum: Self-Directed Triple P uses a self-paced curriculum that families complete on their own time. Telephone calls may be provided to families needing additional support.
Languages Materials are Available in
English
Delivery Mode
Reading on own; optional telephone consultations
Dosage
10 sessions that are done at parents' self-pace; optional phone consultations with a practitioner
Infrastructure for Implementation
Materials: Parent workbook
Staffing Requirements
No direct staff are required for Self-Directed Triple P. It is optional to have a Triple P trained practitioner provide consultative support to families engaging in Self-Directed Triple P.
Training for Model Fidelity
No staffing/training is required, but practitioners may provide supplemental support to participants. Practitioners who provide consultative support on the content of the Self-Directed Triple P program 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 day of pre-accreditation, and a half-day accreditation day. Preparation for the accreditation day requires 4-6 hours of time 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 in 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
The 2023 cost of a Self-Directed Triple P workbook is approxiately $42 each.
Purpose Service Code (PSC)
5505 - Parent Education
Program Identifier (PID)
Positive Parenting Program (Triple P) - Level 4 Self-Directed
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 PARENTING SCALE – LEVEL 4
NCPC Evidence Categorization
Evidence Based- Two randomized control trials with comparison and control groups. However, two of the authors of these studies were directly affiliated with Triple P.
Research Summary
Two of the most relevant publications on Triple P Level 4- Self-Directed include a randomized controlled trial of Self-Directed Triple P among children at risk of developing conduct problems1 and an evaluation comparing Enhanced, Standard, and Self-Directed Triple P with a waitlist control group.2 Sample populations included 63 children ages 2-5 years who were at risk of developing conduct problems and 305 children ages 36-48 months living in low-income areas of Brisbane, Australia. The evaluation by Markie-Dadds and Sanders (2006) found that, post-intervention, the Self-Directed participants reported lower levels of disruptive child behaviors and improvements in parenting satisfaction and efficacy than the waitlist control group. These gains were maintained at the 6-month follow-up. Results of the study by Sanders and colleagues (2000) comparing Enhanced, Standard, and Self-Directed Triple P with a waitlist control group found that the Triple P interventions led to greater improvements than the waitlist condition. There were no statistically significant differences between the Enhanced, Standard, or Self-Directed conditions. The Enhanced condition was associated with the greatest improvements, followed by the Standard, Self-Directed, and waitlist conditions, in that order. Most notably, participants in the Self-Directed condition reported significantly less negative child behaviors and greater parenting competence compared to their peers in the waitlist condition. Analyses indicated that the Enhanced, Standard, and Self-Directed groups were more likely to move from the clinical to non-clinical range on negative child behaviors compared to the waitlist group. Gains were maintained from post-intervention to follow-ups at the 1-year and 3-year mark, although they were not statistically significant.
- ^ See Markie-Dadds & Sanders (2006). This randomized controlled trial compares the outcomes of preschoolers at risk of developing conduct problems whose parents had access to the Triple P Self-Directed program (SD, n = 32) with the outcomes of their peers who were assigned to a waitlist control group (WL, n = 31). The sample population included 63 families with a child between ages 2-5 years (M = 42.91 months in SD, 43.26 months in WL). Children were primarily male (62.5% SD, 64.5% WL) and over a third of mothers (33%) and fathers (37%) had not completed 12 years of schooling (high school-level education attainment). To be eligible for the study, parents had to rate their child's behavior as elevated on the Eyberg Child Behavior Inventory (ECBI) Intensity scale (127) and Problem scale (11). Assessments were completed at baseline, post-intervention, and at 6-month follow-up. Measures included the ECBI, Parent Daily Report (PDR), Parenting Scale (PS), Parenting Sense of Competency Scale (PSOC), Parent Problem Checklist (PPC), Depression Anxiety Stress Scales (DASS), and a Client Satisfaction Questionnaire (CSQ). Participants were randomly assigned to the SD group or the WL group. The SD group received the program consisting of Every Parent and Every Parent's Workbook (now Every Parent's Self-help Workbook). They received brief phone calls at the assessment periods reminding participants to complete survey materials. Approximately 17 weeks after the baseline assessments were completed, families were reassessed post-intervention and the WL group received the intervention. Only the SD group completed the 6-month follow-up assessments. Immediately post-intervention, the SD group reported greater improvements in ECBI Problem (p < 0.01) and Intensity scores (p < 0.005) as well as the PDR mean problem (p < 0.01) and mean targeted scores (p < 0.005), indicating that the children in the SD group displayed significantly lower levels of disruptive child behaviors than their peers in the WL group. The SD group also reported improvements on the PS for over-reactivity (p < 0.01) and PSOC for parenting satisfaction (p < 0.005) and efficacy (p < 0.05). These scores indicated that the SD group was less likely to use authoritarian discipline strategies and more likely to feel satisfied and efficacious in their role as a parent than the WL group. At the 6-month follow-up, the SD group maintained their gains. The only significant finding at follow-up was a decline in PSOC scores for satisfaction (p = 0.04) and efficacy (p = 0.01) from post-intervention to follow-up. The Reliable Change Index (RCI) found that, post-intervention, 30% of the children in the SD group showed clinically reliable improvements in their ECBI intensity scores compared with none of the children in the WL group. At 6-month follow-up, 23% of the children in the SD group showed clinically reliable improvements in their ECBI intensity scores compared with their pre-intervention scores. Study limitations include no method of ensuring that participants complied with or implemented the homework recommended in the program's books, as well as the lack of follow-up assessment of the WL group. Additionally, both authors are directly affiliated with Triple P as the Founder (Sanders) and International Country Director (Markie-Dadds).
- ^ See Sanders et al. (2000). This randomized control trial detailed the three-year outcomes of three Triple P behavioral family intervention (BFI) variants: Standard (STANDARD), Self-Directed (SELF-DIRECTED), and Enhanced (ENHANCED), as well as a waitlist (WL) control group. Participants included 305 families with a child between 36-48 months living in three low-income areas of Brisbane, Australia. These areas report high rates of unemployment, high numbers of families with young children, and high levels of juvenile crime. Families were included based on several criteria, such as concern about their child's behavior (ECBI Intensity score > 127 or Problem score > 11), maternal depression, relationship conflict, low income (less than $345 AUD per week), and other adversity factors. Based on these factors, the sample predominantly consisted of high-risk families. Most families reported having two or more family risk factors, ranging from 52% of the sample having two factors to 12% of families meeting all family risk factor criteria. Families were primarily Caucasian and lower socioeconomic status. Most children were male (68%) and the sample included biological parents, stepparents, single parents, and adoptive/foster parents. Families reported adversity factors such as financial difficulties and family history of substance use, psychiatric illness, and criminal activity. Families also reported elevated scores on the Child Abuse Potential Inventory (56% of mothers and 29% of fathers) and 60% of families indicated 5 or more risk factors for conduct problems out of a total of 25, confirming that parents were at high-risk of physically abusing their child and that children were at high-risk of developing conduct problems. Measures included a family background interview, 30-minute video recording of a home observation coded with the Revised Family Observation Schedule (FOS-RIII), Beck Depression Inventory (BDI), Child Abuse Potential Inventory (CAP), Eyberg Child Behavior Inventory (ECBI), Parent Daily Report (PDR), Parenting Scale (PS), Parenting Sense of Competency Scale (PSOC), Parent Problem Checklist (PPC), Abbreviated Dyadic Adjustment Scale (ADAS), Depression Anxiety Stress Scales (DASS), and Client Satisfaction Questionnaire (CSQ). Assessments were completed pre-/post-intervention and at the 1-year follow-up. Families were randomly assigned to one of the four conditions (ENHANCED, STANDARD, SELF-DIRECTED, or waitlist). The SELF-DIRECTED group received materials and were instructed on how to use them. The ENHANCED and STANDARD groups received 60–90-minute weekly sessions on an individual basis, as provided by trained and supervised practitioners (psychiatrists, clinical psychologists, and psychologists completing postgraduate training) who received supervision from senior clinical psychologists. All groups received two books: Every Parent and Every Parent's Workbook. The STANDARD group completed an average of 10 hours of intervention and the ENHANCED completed approximately 14 hours, which included the additional trainings on partner/social support and coping skills. Post-intervention findings, overall, indicated that families assigned to the three intervention conditions demonstrated improved outcomes compared to their peers in the waitlist group. The ENHANCED condition saw the greatest improvements, followed by STANDARD, SELF-DIRECTED, and the waitlist group, in that order. Compared to the waitlist group, participants in the ENHANCED condition reported: less observed negative child behaviors (p < 0.05); less negative child behaviors reported by mothers (ECBI, p < 0.001 and PDR, p < 0.001) and fathers (ECBI, p < 0.01 and PDR, p < 0.01); less use of dysfunctional discipline strategies by mothers and fathers (PS, p < 0.001 and p < 0.01, respectively); and greater parenting competence among mothers (PSOC, p < 0.001). Compared to the SELF-DIRECTED condition, the ENHANCED group reported: less observed negative child behaviors (p < 0.05); less negative child behaviors reported by mothers (PDR, p < 0.05); less use of dysfunctional discipline strategies by mothers and fathers (PS, p < 0.001 and p < 0.05, respectively); and greater parenting competence among mothers (PSOC, p < 0.05). There were no statistically significant differences between the ENHANCED and STANDARD conditions. Participants in the STANDARD condition reported: less observed negative child behaviors (p < 0.05); less negative child behaviors reported by mothers (ECBI, p < 0.001 and PDR, p < 0.001) and fathers (ECBI, p < 0.001 and PDR, p < 0.01); less use of dysfunctional discipline strategies by mothers and fathers (PS, p < 0.001 and p < 0.05, respectively); and greater parenting competence among mothers (PSOC, p < 0.001) than their peers in the waitlist condition. Compared to the SELF-DIRECTED condition, the STANDARD participants also reported: less negative child behaviors reported by both mothers and fathers (PDR, p < 0.05 for both parents); less use of dysfunctional discipline strategies for mothers (PS, p < 0.001); and greater parenting competence among mothers (PSOC, p < 0.05). Additionally, compared to the waitlist condition, mothers in the SELF-DIRECTED condition reported less negative child behaviors (ECBI, p < 0.05 and PDR, p < 0.05) and greater parenting competence (PSOC, p < 0.05). There were significant differences between conditions for fathers' reports of parent relationships, measured via ADAS and PPC (F(6, 298) = 2.14, p = 0.048). However, there were no significant differences between conditions on the PPC or DASS measures. To assess clinical significance of change, mothers' ECBI and PDR scores were used to calculate the reliable change index (RCI) and researchers assessed the conditions for a 30% reduction rate in observed negative child behaviors. These analyses did not find statistically significant differences in reliable change or 30% reduction between the three intervention groups. However, the analyses indicated that the ENHANCED, STANDARD, and SELF-DIRECTED groups were more likely to move from the clinical to non-clinical range on negative child behaviors compared to the waitlist group. Additionally, more children from the ENHANCED condition moved into the nonclinical range than their peers in the STANDARD condition. One limitation of this study is the high attrition rates among families with the greatest need. Analyses of attrition rates found that families reporting more severe child behavior problems and higher rates of aversive parenting and negative affect were less likely to complete the intervention. Additionally, two of the authors are directly affiliated with Triple P as the Founder (Sanders) and International Country Director (Markie-Dadds).
Researched Population
- Families from Brisbane, Australia
- Families at risk of physically abusing their child
- Low socioeconomic status families
- Children ages 2-5 years
- Families reporting high rates of maternal depression, negative child behaviors, relationship conflict, and other adversity factors
- Children at risk of developing conduct disorders
Clearinghouse and Compendium References
California Evidence-Based Clearinghouse for Child Welfare- Triple P- Positive Parenting Program System rated 2 Supported by Research Evidence and 3 Promising Research Evidence
Home Visiting Evidence of Effectiveness- does not meet criteria
Blueprints Programs- Triple P System rated Promising
Level 4 – Triple P. (n.d.). https://www.triplep.net/glo-en/the-triple-p-system-at-work/the-system-explained/level-4/
Markie-Dadds, C., & Sanders, M. R. (2006). Self-Directed Triple P (Positive Parenting Program) for Mothers with Children at-Risk of Developing Conduct Problems. Behavioural & Cognitive Psychotherapy, 34(3). 259-275. https://doi.org/10.1017/S1352465806002797
Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68(4), 624–640. https://doi.org/10.1037/0022-006X.68.4.624
Local Partnerships Currently Implementing
Local Partnerships in purple have adopted Positive Parenting Program (Triple P) - Level 4 Self-Directed. Local Partnership contact information can be found here.