Positive Parenting Program (Triple P) - Level 5 Enhanced
Category
Family Support
Child's Age
0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years
Participant
Parents/Guardian
Languages
English, Spanish
Brief Description
Intensive support for families with complex concerns, provided in conjunction with or after completing Triple P Level 4- Triple P Standard or Triple P Level 4- Group Triple P. Parents can also be referred by their primary care provider. Parent education program for parents whose family situation is complicated by concerns such as partner conflict, stress, or mental health issues. Parents can complete up to 3 modules addressing partner relationships and communication, personal coping strategies for high stress situations, and other positive parenting practices.
Expected Impact
- Less observed and parent-reported negative child behaviors
- Lower levels of use of dysfunctional discipline practices and conflict over parenting issues
- Greater levels of parenting competence
- More likely to move from the clinical to non-clinical range on negative child behaviors than families in the waitlist condition
- Improved marital satisfaction and communication
Core Components for Model Fidelity
- Weekly Sessions: Participating families complete 60–90-minute weekly sessions on an individual basis, as provided by trained and licensed practitioners. On average, families receive approximately 14 hours of the intervention.
- Session 1: Review session
- Module 1: Practice sessions
- Module 2: Coping skills
- Module 3: Partner support
- Module 4: Maintenance and closure sessions
Languages Materials are Available in
English, Spanish
Delivery Mode
In person, virtual via teleconference or telephone, or a combination
Dosage
Four modules delivered to families in 3-8 individualized consultations, at 60-90 minutes per session.
Infrastructure for Implementation
Materials: Practitioner’s Kit for Enhanced Triple P (includes Practitioner’s Manual, and Every Parent’s Supplementary Workbooks); Access to the Supporting your Partner video; Access to the Coping with Stress video; Access to the Triple P Relaxation audio; For participants - Every Parent's Supplementary Module Workbook with four workbooks in total, one for each module
Staffing Requirements
Staffing requires an Enhanced Triple P Accredited practitioner. They must have completed a Level 3 Primary Care, Primary Care Stepping Stones, or Level 4 Triple P Provider Training Course. This course includes training in Cognitive Behavior Therapy (CBT) and strategies and experience in this area is an advantage when complete the course. Based on the research, it is recommended that these practitioners be licensed mental health practitioners, such as psychiatrists, clinical psychologists, or psychologists completing postgraduate training.
To complete Triple P Provider Training, it is recommended by the purveyor that participants have a post-high school degree in health, education, early childhood education, or social services. However, para-professionals who actively work with families may also be suitable for training (e.g., home health visitors and parent partners). Paraprofessionals are expected to have knowledge of child and adolescent development, and/or experience working with families.
For Level 5, the content is a bit more clinical in nature, and practitioners with a post high school degree is strongly recommended. Paraprofessionals can still train in Level 5. It is encouraged that they have access to a supervisor or team with clinical experience, so that they can process complex family needs or concerns that feel out of their scope to manage.
Triple P practitioners are not restricted to only delivering 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 2 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 Level 5 Enhanced virtual Open Enrollment is $2200/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 $31,910 (which equates to approximately $1595.50 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 Enhanced Triple P is approximately $52/parent. The costs noted here are just for training and parent materials. Other start up costs will depend on the agency and the specific practictioner.
Purpose Service Code (PSC)
5505 - Parent Education
Program Identifier (PID)
Positive Parenting Program (Triple P) - Level 5 Enhanced
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 LEVEL 5 MEASURE
NCPC Evidence Categorization
Evidence Based- Two randomized control trial 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 5- Enhanced include an evaluation comparing Enhanced, Standard, and Self-Directed Triple P with a waitlist control group1 and a study comparing Enhanced Triple P with Standard Triple P.2 Sanders and associates’ (2000) sample population consisted of 305 families with a child between 36-48 months living in three low-income areas of Brisbane, Australia that report high rates of unemployment, high numbers of families with young children, and high levels of juvenile crime. Families were primarily Caucasian and had a lower socioeconomic status, and most children were male (68%). Families reported elevated scores on the Child Abuse Potential Inventory indicating high-risk of physically abusing their child and that children were at high-risk of developing conduct problems. Ireland et al. (2003) sampled 37 families with a child ages 2-5 years whose parents reported clinically significant levels of marital conflict (Parent Problem Checklist (PPC) scores of 5 or higher) and concerns about managing their child's behavior. The study took place in Australia with services provided at the University of Queensland. Most participants identified as Caucasian, had a male child (65%), and were college/university graduates (62% of mothers, 62.5% of fathers). About half of participants rated their child's behavior on the Eyberg Child Behavior Inventory (ECBI) Intensity scale in the clinically elevated range (46% of mothers, 43% of fathers). Results of these studies ultimately found that the Triple P interventions led to greater improvements than the waitlist condition, but there were not 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. Sanders et a. (2000) found that the Enhanced condition showed less observed and parent-reported negative child behaviors, lower levels of use of dysfunctional discipline practices and conflict over parenting issues, and greater levels of parenting competence. Families in the Enhanced condition were also more likely to move from the clinical to non-clinical range on negative child behaviors than families in the waitlist condition. Gains were maintained from post-intervention to follow-ups at the 1-year and 3-year mark, although they were not statistically significant. Ireland et al. (2003) similarly found that both the Enhanced and Standard conditions reported improvements in child behaviors, dysfunctional parenting practices, and marital adjustment after completing the intervention, with limited statistically significant differences between groups. Fathers in both groups reported significant reductions in their child's disruptive behaviors from pre-intervention to follow-up. Fathers in the Enhanced group reported significant improvements in parenting skills at post-intervention and follow-up. Parents in both conditions reported significantly greater agreement between parents from pre- to post-intervention, but only the Standard group maintained these gains at follow-up. At follow-up, parents in the Enhanced group reported greater clinically reliable improvements on the ECBI Problem scale than the families in the Standard condition.
- ^ See Sanders et al. (2000). This randomized control trial detailed the three-year outcomes of three Triple P behavioral family intervention (BFI) variants: Standard (SBFI), Self-Directed (SDBFI), and Enhanced (EBFI), 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 (EBFI, SBFI, SDBFI, or waitlist). The SDBFI group received materials and were instructed on how to use them. The EBFI and SBFI 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 SBFI group completed an average of 10 hours of intervention and the EBFI 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 EBFI condition saw the greatest improvements, followed by SBFI, SDBFI, and the waitlist group, in that order. Compared to the waitlist group, participants in the EBFI 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 SDBFI condition, the EBFI 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 EBFI and SBFI conditions. Participants in the SBFI 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 SDBFI condition, the SBFI 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 SDBFI 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 EBFI, SBFI, and SDBFI 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 EBFI condition moved into the nonclinical range than their peers in the SBFI 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).
- ^ See Ireland et al. (2003). This study compared the outcomes of Standard Group Triple P (SGTP) and Enhanced Group Triple P (EGTP) by randomly assigning families to either condition. The sample population included 37 families with a child ages 2-5 years (SGTP M = 3.53, n = 19; EGTP M = 3.78, n = 18) whose parents reported clinically significant levels of marital conflict (Parent Problem Checklist (PPC) scores of 5 or higher) and concerns about managing their child's behavior. The study took place in Australia with services provided at the University of Queensland. Most participants identified as Caucasian, had a male child (65%), and were college/university graduates (62% of mothers, 62.5% of fathers). About half of participants rated their child's behavior on the Eyberg Child Behavior Inventory (ECBI) Intensity scale in the clinically elevated range (46% of mothers, 43% of fathers). Assessments were completed pre-intervention, immediately post-intervention, and at 3-month follow-up. Measures included a family background questionnaire, ECBI, Parenting Scale (PS), PPC, Depression Anxiety Stress Scale (DASS), Abbreviated Dyadic Adjustment Scale (ADAS), Marital Communication Inventory (MCI), ENRICH Marital Satisfaction Scale (EMS), and Client Satisfaction Questionnaire (CSQ). After ascertaining eligibility for study inclusion via a brief telephone interview that included completion of the PPC, families self-selected a group time to attend. Conditions were then randomly allocated to group times. Participants completed the program in 8 weeks, with SGTP consisting of four 2-hour group sessions, four 15-30 minute telephone consultations, and access to the Every Parent's Group Workbook and EGTP consisting of the SGTP components as well as two additional 90-minute group sessions focused on partner support. Both parents were required to attend each group session, with very high attendance rates; 94% of EGTP participants completed at least 9 of the 10 sessions and 100% of SGTP participants completed at least 7 of the 8 sessions. Group sessions were facilitated by psychologists who were accredited Triple P providers. Results indicated that, overall, both the EGTP and SGTP groups reported improvements in child behaviors, dysfunctional parenting practices, and marital adjustment after completing the intervention. The outcomes of the EGTP and SGTP groups were very similar. Fathers in both groups reported significant reductions in their child's disruptive behaviors from pre-intervention to follow-up (p < 0.005), as measured by the ECBI Intensity score, and fathers in the EGTP group also reported significant improvements from pre-intervention to post-intervention (p < 0.005). Fathers in the EGTP group reported significant improvements in parenting skills at post-intervention and follow-up (p < 0.005), measured by the PS. Mothers and fathers in both groups reported significant improvements on the PPC Problem and Intensity scales from pre-intervention to post-intervention, which were maintained at follow-up (p-values ranging from p < 0.05 to p < 0.0005). Parents in both conditions reported significant reductions in EMS Couple Agreement scores from pre-intervention to post-intervention (p-values ranging from p < 0.05 to p < 0.005), indicating greater agreeance between parents, but only the SGTP group maintained these gains at follow-up. Fathers in the EGTP condition and mothers in the SGTP group reported significant improvements in EMS Satisfaction scores from pre- to post-intervention which were maintained at follow-up (p-values ranging from p < 0.05 to p < 0.005), indicating greater satisfaction in their marriage. The researchers assessed the reliable change index (RCI) and functional recovery (FR) to identify the clinical significance of change and found that, at follow-up, parents in the EGTP group reported greater clinically reliable improvements (44% mothers, 44% fathers) and FR (89% mothers, 78% fathers) on the ECBI Problem scale than the SGTP group (29%, 19%, 57%, and 57%, respectively). Mothers' responses to the PPC indicated that 63% of couples in the EGTP condition demonstrated clinically reliable improvement and FR, compared with 69% of the SGTP group achieving FR and 81% achieving clinically reliable improvements on the PPC. Study limitations include the absence of a control group, differing amounts of contact with therapists/facilitators, and a reliance on parent-reported measures. 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 36-48 months
- Families reporting high rates of maternal depression, negative child behaviors, relationship conflict, and other adversity factors
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
Ireland, J. L., Sanders, M. R., & Markie-Dadds, C. (2003). The impact of parent training on marital functioning: a comparison of two group versions of the Triple P Positive Parenting Program for parents of children with early-onset conduct problems. Behavioural and Cognitive Psychotherapy, 31(2). 127-142. https://doi.org/10.1017/S1352465803002017
Level 5 – Triple P. (n.d.). https://www.triplep.net/glo-en/the-triple-p-system-at-work/the-system-explained/level-5/
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 5 Enhanced. Local Partnership contact information can be found here.