Panel Presentation from the Evidence Based Parenting Programmes and Social Inclusion conference held at Middlesex University, 20th September 2012

1. Triple P-Positive Parenting Program®
Dr Majella Murphy & Meave Darroux
1

2. Outline
• Overview of the Triple P system
– What is Triple P?
– Case study
• Overview of Triple P Provider Training
– Training, Accreditation, Courses on
offer
• Questions

3. Why do we need parenting programs?
A disturbingly large number of
children develop significant social,
behavioural and emotional problems
that are preventable

4. No group has a monopoly on either
coercive or positive parenting practices
100
90
Percentage of parents
80
70
60
50
40
30
20
10
0
Threaten Shout Single spank Spank with object
Inappopriate Strategy
Low Lower Middle Upper Middle High

5. The case for a population based
approach to supporting parents
• Parenting has a pervasive impact
on children’s development
• Parenting programs benefit both
children and parents
• Potential impact is diminished
because many programs reach
relatively few parents

6. What is Triple P?
• Flexible system of parenting and family support
• Evidence-based
• Prevention / early intervention approach
• Five intervention levels of increasing intensity
• Principle of sufficiency
• Multidisciplinary focus

7. What makes Triple P different?
• A public health model of parenting intervention
• Suite of evidence based programs not a
single program from infancy through to
adolescence-5 levels, 4 delivery modalities
• Blends universal and targeted programs
• Uses self regulatory framework

8. Theoretical Basis of Triple P
• Social learning models of parent-child
interaction
• Child and family behaviour therapy research
• Developmental research on parenting in
everyday contexts and social competence
• Social information processing models
• Developmental psychopathology research
• Public/population health framework

9. Research evidence
• Studies conducted on each intervention level
and delivery format with consistent results
– Fewer behavioural and emotional problems in
children
– Greater parental confidence and use of positive
parenting
– Less negative parenting, stress, depression, and
anger
– Less marital conflict over parenting
• Independent replications of main findings across
different sites, cultures and countries

10. Evidence with high need groups
• Parents at risk of abuse (Sanders et al, 2004)
• Depressed parents of children with conduct problems (Sanders &
McFarland, 2000)
• Parents who have separated or divorced (Stallman & Sanders,
2007)
• Maritally discordant parents (Dadds, Schwartz & Sanders, 1987)
• Parents of children with ADHD (Hoath & Sanders, 2004)
• Parents of children with developmental disabilities (Plant &
Sanders, 2007)
• Parents of children with chronic illnesses (Morawska & Sanders,
2008)
• Parents of children with feeding disorders (Sanders & Turner, 2000)
• Parents of children with recurrent pain syndromes (Sanders et al,
1994)
• Parents of gifted and talented children (Morawska & Sanders,
2007)

11. Current international trials
• Belgium (University of Antwerp)
• The Netherlands (Trimbos Institute)
• Sweden (University of Uppsala)
• Germany (University of Braunschweig)
• Switzerland (University of Friborg)
• Canada (University of Manitoba; UBC)
• USA (Oregon Research Institute, USC)
• England (University of Manchester, Oxford University,
Cambridge University, University of Birmingham)
• NZ (University of Auckland, University of Waikato, University
of Canterbury)
• Iran (Medical University of Tehran)
• Japan (University of Tokyo, University of Wakayama)
• Hong Kong (DOH)

12. Countries Disseminating Triple P
Watch this
space......
Australia Germany
New Zealand Chile
The Netherlands &
BES Islands
Canada France
Belgium
United States
Portugal
Switzerland
Ireland
Sweden Turkey
Scotland
Singapore Estonia
England
Japan
Wales Panama
Hong Kong
Iran
Austria
Curacao
Romania
Luxembourg

13. Principles and Strategies underlying
Triple P
13

14. Principles of positive parenting
• Ensuring a safe, engaging
environment
• Creating a positive learning
environment
• Using assertive discipline
• Having realistic expectations
• Taking care of yourself as a
parent

15. 17 Core Parenting Skills
Promoting good Encouraging good
relationships behaviour
-Spending time with children - Praise
- Talking to children -Attention
- Affection -Interesting activities
Managing misbehaviour
Teaching new skills and
behaviours - Ground rules
- Directed discussion
- Setting a good example
- Planned ignoring
- Incidental teaching
- Clear, calm instructions
- Ask-say-do
- Logical consequences
- Behaviour charts
- Quiet time
- Time-out

16. Triple P intervention levels
1. Universal Triple P
Media-based parenting information campaign
2. Selected Triple P
Information/advice for a specific parenting concern
3. Primary Care Triple P
Narrow focus parenting skills training
4. Standard/Group/Self-Directed Triple P
Broad focus parenting skills training
5. Enhanced Triple P
Behavioural family intervention

17. The Triple P System

18. Level 4
Broad Focus Parent Training
18

19. Level 4: Group Triple P
• Groups of 10-12 parents
• Active skills training in small
groups
• 8 session group program
– 4 x 2 hour group sessions
– 3 x 15-30 minute telephone sessions
– Final group / telephone session options
• Supportive environment
• Normalise parenting
experiences

20. Level 4: Standard Triple P
• Broad focus parent skills training
• Active skills training
• Generalisation enhancement strategies
• 10 sessions
– Assessment and feedback
– Causes of children’s behaviour problems
– Positive parenting strategies
– Practice
– Planned activities for high-risk settings
– Maintenance

21. Level 4: Self-Directed Triple P
• Parent workbook
• 10 week self-directed program
– Set readings
– Practice tasks
• Optional telephone consultations
– Minimal support
– Prompt self-directed learning and problem solving

22. Benefits of broad focus interventions
• Addresses complex child behaviour problems
• Addresses child behaviour problems occurring in
multiple settings e.g. home, school and public
settings
• Normalises parenting experiences
• Referral of severe child behaviour problems to
specialised services

23. Triple P Parallel Programs
23

24. Program Variants

25. Teen Triple P
• For parents of teenagers or children making the
transition to high school
• Program variants
– Selected
– Primary care
– Group
– Standard
– Self-directed

26. Stepping Stones
• For parents of children who have mild to
moderate disabilities
• All modalities are available including:
– Primary Care
– Group
– Standard

27. Level 5
Intensive Family Intervention
27

28. Level 5: Enhanced Triple P
• Adjunct to other intervention levels
• Review and feedback
• Negotiation of additional modules tailored to
family’s needs
– Practice Module
– Coping Skills Module
– Partner Support Module
• Maintenance and closure

29. Level 5: Enhanced Triple P
Group
Triple P
plus
Coping Skills Partner Support
Module Module
Practice
Module

30. Level 5: Pathways Triple P
• Extra Level 5 modules
• For parents at risk of maltreating their
children, parents with prior abuse
notification, or parents with anger
management problems
• Attribution Retraining Module
(re child’s and own behaviour)
• Anger Management Module

31. Level 5: Pathways Triple P
Group
Triple P
plus
Attributional
retraining Anger
Management
Explanations Explanations
For child’s For own
behaviour behaviour

32. Family Transitions Triple P
• For parents and families experiencing separation
and divorce
• Variation of Group Triple P
(5 additional sessions)
• Personal adjustment following divorce
• Strategies for
– improving coping skills, reducing parenting stress anxiety,
anger and depression, reducing conflict between parents &
improving communication, promoting work, family, play
balance and gaining appropriate social support
• Helping parents develop independent problem
solving skills

33. Lifestyle Triple P
• For parents of overweight and obese children
• Variation of Group Triple P
(14 session program)
• Strategies for
– increasing self-esteem and reducing problem
behaviour
– promoting healthy eating
– increase physical activity and reducing sedentary
activities

34. Research update
34

35. United States – Population trial
• 18 counties
– Triple P System
– Comparison (services as usual)
• Government records for maltreatment were
monitored

36. Effect sizes in human terms
• Assume a population with 100,000 children
under 8 years of age
• What we found …….
– 688 fewer substantiated cases of child maltreatment
per year
– 240 fewer child out-of-home placements per year
– 60 fewer hospitalized or ER treated children with
child-maltreatment injuries per year

37. Driving Mum and Dad Mad
Research
• 723 parents
• Significant improvements in child behaviour,
dysfunctional parenting, parental anger,
depression and self-efficacy after watching the
series
• Improvements maintained at 6 months follow up
• Parents who watched the entire series had more
severe problems at pre and high socio-
demographic risk
• Media interventions may be engagement
strategy for hard to reach families

38. Triple P in practice – Case Study
An example of how 1-1 Triple P strategies were
used within a child protection plan.

39. Triple P Provider Training &
Accreditation

40. Triple P Provider Training Courses
Completion of each of the following 5 steps is
essential for the successful implementation of Triple P.
• Attendance at a training course (Part 1)
• Completion of set readings
• Implementation of Triple P in the workplace including
development of peer support networks.
• Completion of accreditation requirements (Part 2)
• Access to Triple P Provider Network (web based)

41. Accreditation Overview
• 2 to 3 months after the initial training
• Take Home Quiz
• Expert feedback on core competencies
• Details of accreditation are provided during each
Triple P Provider Training Course.

42. Triple P Practitioner Resources
• Each practitioner receives (eg Group Triple P):
• Facilitator’s Kit for Group Triple P
– Facilitator’s Manual for Group Triple P
– PowerPoint Presentation CD
– Copy of Every Parent’s Group Workbook.
• Every Parent’s Survival Guide [DVD]

43. Triple P Resources for parents
• Parent tip sheets
• Parent workbooks
• Practitioner manuals
• Practitioner teaching aids
(e.g., PowerPoint presentations,
desktop flip chart)
• DVD’s
Parent Resources are essential for the successful
implementation of Triple P. These resources are
protected by copyright.

44. Triple P Pactitioners’ Network
www.triplep.net
The Practitioner Network provides:
• Clinical tools e.g. Assessment measures,
checklists and parent worksheets
• Promotional materials e.g. Posters and
brochures
• Question and answer forum
• Radio podcasts
• Suggested reading lists and additional
information

45. The differences between practitioners
that use Triple P and those that don’t
Practitioners more likely to use if:
• Have completed accreditation (Seng, Prinz &
Sanders, 2006)
• Have greater line management support
(Turner, Nicholson & Sanders, 2005)
• Identify fewer barriers to program
implementation (Seng et al, 2006)
• Have higher self efficacy post training (Turner
et al, 2006)

46. Barriers to Usage
Practitioners less likely to use if:
• Insufficient knowledge and skills
• Received a lack of recognition from colleagues
for their Triple P work
• Had difficulty coordinating with other
practitioners
• After hours appointments clash with other
commitments

47. Questions?
47

48. Further information
• General Information
www.triplep.net
• Training queries (Triple P UK)
Email: Jo Andreini (jo@triplep.uk.net) or Majella Murphy
(majella@triplep.net)
• Research (University of Queensland)
www.pfsc.uq.edu.au/evidence
Thank you for your time and attention!