Quality of Research
Review Date: January 2008
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Sanders, M. R., Bor, W., & Morawska, A. (2008). Long term maintenance effects of three variants of the Triple P-Positive Parenting Program for early onset conduct problems. Manuscript submitted for publication.
Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The 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.  Study 2Leung, C., Sanders, M. R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544. Study 3Zubrick, S. R., Ward, K. A., Silburn, S. R., Lawrence, D., Williams, A. A., Blair, E., et al. (2005). Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prevention Science, 6(4), 287-304. Study 4Hoath, F. E., & Sanders, M. R. (2002). A feasibility study of enhanced group Triple P--Positive Parenting Program for parents of children with attention-deficit/hyperactivity disorder. Behaviour Change, 19(4), 191-206. Study 5Turner, K. M. T., & Sanders, M. R. (2006). Help when it's needed first: A controlled evaluation of brief, preventive behavioral family intervention in a primary care setting. Behavior Therapy, 37(2), 131-142.
Outcomes
| Outcome 1: Negative and disruptive child behaviors |
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Description of Measures
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Negative and disruptive child behaviors were measured by systematic, direct observation using the Family Observation Schedule and by parental reports using the Eyberg Child Behavior Inventory, the Parent Daily Report, the Strength and Difficulty Scale, and the Child Attention Problems Rating Scale.
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Key Findings
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In one study in Australia, families with a 3-year-old received Enhanced Triple P (ETP; level 5), Standard Triple P (STP; level 4), or a self-directed version of Triple P (SDTP; level 4) or were randomly assigned to a wait-list control group. After the intervention:
- Children of families who received ETP showed significantly less observed negative behavior than children of families who received SDTP (p < .05) or children of control group families (p < .05). Children of families who received STP also showed significantly less observed negative behavior than children of families who received SDTP (p < .05).
- Mothers of families who received ETP reported less negative child behavior than mothers of families who received SDTP (p < .05) or mothers of control group families (p < .001). Similarly, mothers of families who received STP reported fewer child behavior problems than mothers of families who received SDTP (p < .05) or mothers of control group families (p < .001). Mothers of families who received SDTP also reported fewer child behavior problems than mothers of control group families (p < .05).
- Fathers of families who received either ETP or STP reported less negative child behavior than fathers of control group families (p < .01) and fewer child behavior problems than fathers of families who received SDTP (p < .05).
- On two measures of clinically significant change in observed child disruptive behavior (i.e., a score above 1.96 on the Reliable Change Index and a 30% reduction):
- Children of families who received ETP were more likely than children of families who received SDTP (p < .05) or children of control group families (p < .001) to demonstrate clinically significant reductions in disruptive behavior.
- Children of families who received STP were more likely than children of control group families to demonstrate clinically significant reductions in disruptive behavior (p < .01).
- Children of families who received any version of Triple P were more likely than children of control group families to move from the clinical to the normal range of functioning on disruptive behavior (p < .01 or less, depending upon the version of Triple P received).
In a study conducted in Hong Kong, Chinese families with a child 3-7 years old received Triple P or were randomly assigned to a wait-list control group. After the intervention:
- Parents of families who received Triple P reported fewer child behavior problems (p < .001) and lower problem intensity (p < .001) than parents of control group families. Parents of families who received Triple P also reported fewer conduct problems (p = .002), peer problems (p = .03), and emotional symptoms (p = .03) and less hyperactivity (p = .03) than parents of control group families (p < .005).
- Within families who received Triple P, parents of male children reported lower postintervention scores on hyperactivity and conduct problems than parents of female children (p < .05 for both variables).
In a study conducted in Australia, families with a preschooler received Enhanced Group Triple P or were randomly assigned to a no-intervention control group. At posttest:
- Parents of families who received Triple P reported greater improvements in child behaviors (p < .05) compared with parents of families in the control group. This finding was still statistically significant 12 and 24 months following the intervention.
- In an analysis of the clinical significance of outcomes, 77% of families who received Triple P underwent clinically reliable change in child problem behavior, compared with only 18% of control group families.
In another Australian study, families with a child 5-9 years old who had attention-deficit/hyperactivity disorder (ADHD) received Enhanced Triple P (level 5) or were randomly assigned to a wait-list control group. Although both groups improved from baseline to posttest, parents of families who received Triple P reported lower levels of disruptive child behavior (p < .05) than parents of control group families.
In a fourth Australian study, low-income families with a child 2-6 years old received Primary Care Triple P (level 3) or were randomly assigned to a wait-list control group. After the intervention:
- Parents of families who received Triple P reported significantly fewer targeted problem behaviors than parents of control group families (p < .001).
- Mothers of families who received Triple P reported child behavior problems occurring in fewer settings than parents of control group families (p = .014).
- In an analysis of clinically significant outcomes, compared with control group families, a greater proportion of families who received Triple P reached reliable change in a positive direction on parental reports of the number of settings in which problem behavior occurs (p = .011).
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4, Study 5
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Study Designs
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Experimental, Quasi-experimental
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Quality of Research Rating
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2.9
(0.0-4.0 scale)
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| Outcome 2: Negative parenting practices as a risk factor for later child behavior problems |
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Description of Measures
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Negative parenting practices (e.g., negative, coercive, or inadequate parenting, parental stress) were measured by systematic, direct observation using the Family Observation Schedule and by self-report using the Parenting Scale, the Parenting Sense of Competence Scale, and the Depression-Anxiety-Stress Scale.
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Key Findings
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In one study in Australia, families with a 3-year-old received Enhanced Triple P (ETP; level 5), Standard Triple P (STP; level 4), or a self-directed version of Triple P (SDTP; level 4) or were randomly assigned to a wait-list control group. After the intervention:
- Mothers and fathers of families who received ETP or STP reported less frequent use of dysfunctional discipline strategies than mothers and fathers of control group families (p < .001 to p < .05).
- Mothers and fathers of families who received ETP reported less use of dysfunctional discipline than mothers and fathers of families who received SDTP (p < .001 to p < .05).
- Mothers of families who received STP reported less use of dysfunctional discipline than mothers of families who received SDTP (p < .001).
- Mothers of families who received STP or ETP reported greater parenting competence than mothers of families who received SDTP (p < .05) or mothers of control group families (p < .001). Mothers of families who received SDTP reported greater parenting competence than mothers of control group families (p < .001).
In a study conducted in Hong Kong, Chinese families with a child 3-7 years old received Triple P or were randomly assigned to a wait-list control group. After the intervention:
- Compared with control group parents, parents of families who received Triple P had lower scores on the use of dysfunctional parenting behavior (p < .001), including lower subscale scores on laxness (p < .001), overreactivity (p = .002), and verbosity (p < .001).
- Compared with control group parents, parents of families who received Triple P had lower scores on perceived parental problems (p < .001) and higher scores on perceived parent sense of competence (p < .001), including higher subscale scores on parental efficacy (p < .001) and satisfaction (p = .007).
In a study conducted in Australia, families with a preschooler received Enhanced Group Triple P or were randomly assigned to a no-intervention control group. At posttest:
- Parents of families who received Triple P had larger reductions in the overall reported use of dysfunctional parenting (p < .05), including subscale scores for laxness (p < .05), overreactivity (p < .05), and verbosity (p < .05), than parents of control group families. This finding was still statistically significant at 12 and 24 months following the intervention.
- Parents of families who received Triple P had larger reductions in reported caregiver depression (p < .05), anxiety (p < .05), and stress (p < .05) than parents of control group families. This finding was still statistically significant at 12 and 24 months following the intervention.
- Parents of families who received Triple P had larger reductions in reported conflict between partners over child rearing than parents of control group families (p < .05). This finding was not robust at 12 months but was statistically significant at 24 months following the intervention.
In another Australian study, families with a child 5-9 years old who had ADHD received Enhanced Triple P (level 5) or were randomly assigned to a wait-list control group. At posttest, parents of families who received Triple P had significant reductions in their reported use of verbosity compared with parents of control group families.
In a fourth Australian study, low-income families with a child 2-6 years old received Primary Care Triple P (level 3) or were randomly assigned to a wait-list control group. After the intervention:
- Mothers of families who received Triple P reported less use of dysfunctional parenting strategies than mothers of control group families (p = .001).
- In an analysis of clinically significant outcomes, compared with control group families, a greater proportion of families who received Triple P reached reliable change in a positive direction on parental reports of verbosity (p = .006).
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4, Study 5
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Study Designs
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Experimental, Quasi-experimental
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Quality of Research Rating
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2.9
(0.0-4.0 scale)
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| Outcome 3: Positive parenting practices as a protective factor for later child behavior problems |
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Description of Measures
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Positive parenting practices were measured by self-report using the Parenting Scale and the Parenting Sense of Competence Scale.
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Key Findings
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In one study in Australia, families with a 3-year-old received Enhanced Triple P (ETP; level 5), Standard Triple P (STP; level 4), or a self-directed version of Triple P (SDTP; level 4) or were randomly assigned to a wait-list control group. After the intervention:
- Mothers of families who received STP or ETP reported greater parenting competence than mothers of families who received SDTP (p < .05) or mothers of control group families (p < .001).
- Mothers of families who received SDTP also reported greater parenting competence than mothers of control group families (p < .001).
In a study conducted in Hong Kong, Chinese families with a child 3-7 years old received Triple P or were randomly assigned to a wait-list control group. After the intervention, compared with parents of control group families, parents of families who received Triple P had lower scores on perceived parental problems (p < .001) and higher scores on perceived parent sense of competence (p < .001), including higher subscale scores on parental efficacy (p < .001) and satisfaction (p = .007).
In a study conducted in Australia, families with a child 5-9 years old who had ADHD received Enhanced Triple P (level 5) or were randomly assigned to a wait-list control group. At posttest, compared with parents of control group families, parents of families who received Triple P reported higher levels of confidence in successfully dealing with their child's disruptive behaviors in a variety of settings.
In another Australian study, low-income families with a child 2-6 years old received Primary Care Triple P (level 3) or were randomly assigned to a wait-list control group. After the intervention:
- Mothers of families who received Triple P reported significantly greater satisfaction with parenting (p = .005) and significantly lower anxiety and stress (p = .005) than mothers of control group families.
- In an analysis of clinically significant outcomes, compared with control group families, a greater proportion of families who received Triple P reached reliable change in a positive direction on parental reports of parenting satisfaction (p = .005).
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Studies Measuring Outcome
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Study 1, Study 2, Study 4, Study 5
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Study Designs
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Experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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0-5 (Early childhood)
26-55 (Adult)
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68% Male
32% Female
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100% Non-U.S. population
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Study 2
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0-5 (Early childhood)
6-12 (Childhood)
26-55 (Adult)
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58% Male
42% Female
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100% Non-U.S. population
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Study 3
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0-5 (Early childhood)
26-55 (Adult)
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57% Male
43% Female
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100% Non-U.S. population
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Study 4
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6-12 (Childhood)
26-55 (Adult)
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80% Male
20% Female
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100% Non-U.S. population
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Study 5
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0-5 (Early childhood)
26-55 (Adult)
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53% Male
47% Female
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100% Non-U.S. population
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Negative and disruptive child behaviors
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3.2
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3.1
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3.2
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2.8
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2.5
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2.9
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2.9
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2: Negative parenting practices as a risk factor for later child behavior problems
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3.2
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3.2
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3.1
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2.9
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2.5
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2.6
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2.9
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3: Positive parenting practices as a protective factor for later child behavior problems
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3.2
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3.2
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3.2
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2.8
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2.6
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2.9
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3.0
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Study Strengths The psychometric properties of the outcome measures are adequate, the intervention implementation was enhanced by a series of procedures to ensure program fidelity, and the analyses used were appropriate.
Study Weaknesses Some studies showed improvement in both intervention and comparison groups at the postintervention assessment, which may indicate the influence of confounding variables. The statistical power of some analyses in two of the studies may have been low due to small sample sizes and large standard deviations.
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Readiness for Dissemination
Review Date: January 2008
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Markie-Dadds, C., Sanders, M. R., & Turner, K. M. (2000). Every parent's family workbook. Milton, Queensland, Australia: Triple P International.
Program Web site, http://www.triplep-america.com
Sanders, M. R. (2000). Triple P Positive Parenting Program: Level 4 standard professional training course [PowerPoint slides].
Sanders, M. R., Markie-Dadds, C., & Turner, K. M. (2001). Practitioner's manual for Standard Triple P. Milton, Queensland, Australia: Triple P International.
Sanders, M. R., Markie-Dadds, C., & Turner, K. M. (2002). Positive Parenting. Milton, Queensland, Australia: Triple P International.
Triple P Positive Parenting Program Description and Supporting Documentation
Triple P Positive Parenting Program: Level 4 professional training course participant notes. (1998).
Triple P Practitioner Network Web site, http://www.triplep.org
Triple P Tip Sheet Sampler Set
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.8
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4.0
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3.8
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3.8
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Dissemination Strengths The practitioner's manual is easy to navigate and provides detailed instructions on all aspects of program implementation. Formal training on each of the five program levels is available to organizations implementing this program. Extensive training and implementation support is accessible to implementers through the Triple P Practitioner Network. An array of standardized assessment instruments is provided to implementers to measure the progress of families participating in the program. Session fidelity summaries are completed by implementers to support quality assurance.
Dissemination Weaknesses Some of the written materials for parents are quite dense and assume parents have reading comprehension skills at the 6th-grade level or above. Materials include limited discussion on how to adapt the curriculum so it is culturally appropriate for participating families. No protocol for routine supervision of quality assurance measures was provided.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Parent workbooks
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$20-$32 per participant
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Yes
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Positive parenting booklets
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$6.50 per participant
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Yes
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Parenting tip sheets
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$8-$11 for a set of 10
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Yes
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2- to 3-day, on-site training and half-day follow-up training (includes session fidelity checklists and pre-and posttest assessment measures)
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$21,415-$26,195 per site for up to 20 practitioners, depending on level of training
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Yes
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Telephone consultation
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$200 per hour
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No
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Clinical support
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$3,035 per day
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No
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Pre- and postaccreditation quality assurance support
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$3,035 per day
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No
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
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, 127-142.
Markie-Dadds, C., & Sanders, M. R. (2006). A controlled evaluation of an enhanced self-directed behavioural family intervention for parents of children with conduct problems in rural and remote areas. Behaviour Change, 23(1), 55-72.
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 and Cognitive Psychotherapy, 34(3), 259-275.
Martin, A. J., & Sanders, M. R. (2003). Balancing work and family: A controlled evaluation of the Triple P-Positive Parenting Program as a work-site intervention. Child and Adolescent Mental Health, 8(4), 161-169.
McTaggart, P., & Sanders, M. R. (2003). The Transition to School Project: Results from the classroom. Australian e-Journal for the Advancement of Mental Health, 2(3), 1-12.
Morawska, A., & Sanders, M. R. (2006). Self-administered behavioral family intervention for parents of toddlers: Part I. Efficacy. Journal of Clinical and Consulting Psychology, 74(1), 10-19.
Plant, K. M., & Sanders, M. R. (2007). Predictors of care-giver stress in families of preschool-aged children with developmental disabilities. Journal of Intellectual Disability Research, 51(2), 109-124.
Ralph, A., & Sanders, M. R. (2003). Preliminary evaluation of the Group Teen Triple P program for parents of teenagers making the transition to high school. Australian e-Journal for the Advancement of Mental Health, 2(3), 1-10.
Roberts, C., Mazzucchelli, T., Studman, L., & Sanders, M. R. (2006). Behavioral family intervention for children with developmental and behavioral problems. Journal of Clinical Child and Adolescent Psychology, 35(2), 180-193.
Sanders, M. R., Pidgeon, A., Gravestock, F., Connors, M. D., Brown, S., & Young, R. (2004). Does parental attributional retraining and anger management enhance the effects of the Triple P-Positive Parenting Program with parents at-risk of child maltreatment? Behaviour Therapy, 35(3), 513-535.
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