Triple P - Positive Parenting Program^®—Variants suitable for home visiting

Triple P – Positive Parenting Program^® (Triple P) is a parenting and family support system designed to prevent and treat behavioral and emotional problems in children from birth through their teenage years. To meet the needs of different families and implementing agencies, the Triple P system includes interventions that increase in intensity across five levels of service. The system also includes a range of delivery methods (such as one-on-one consultations in the home or group seminars) and can be provided by staff from multiple disciplines (including paraprofessionals, counselors, and nurses). The intensity and length of services also vary by intervention. For example, Primary Care Triple P (Level 3) includes approximately four weekly individual consultations of 15 to 30 minutes each, and Enhanced Triple P (Level 5) includes approximately eight weekly individualized sessions, each lasting 60 to 90 minutes.

The HomVEE review is based on studies of programs that provided Triple P services in the home to families with children from birth through age 5 (Triple P–Variants suitable for home visiting).

This report also includes reviews of one module (Child Management Training) of a Level 4 Triple P intervention and a version of an adaptation of Triple P (Standard Stepping Stones Triple P) for children with a disability; both of which are suitable for delivery in the home. During the Child Management Training module, practitioners meet with parents in the home and explain how parents can help teach their children new behaviors using strategies such as descriptive praise and contingent consequences. The practitioner provides verbal and written instruction and models behavior in an effort to teach parents steps intended to modify their child’s behavior. Then, the practitioner observes parent–child interactions and provides verbal feedback and written enrichment materials. (As Triple P was being developed, this module was originally called Instructions + Feedback.) Standard Stepping Stones is an adaptation of Triple P intended specifically for parents of children with disabilities. It provides assessment of parenting strategies and then instruction and support that aim to promote child competencies in social and language skills, emotional skills, independence, and problem solving.

Note: For this model, several Triple P studies compared various components of the model, sometimes in a single-case design format with multiple phases. For screening and reviewing studies, we focused on those with a contrast between Triple P—Home Visiting and a non-Triple P condition. Comparisons between different home visiting components within the same model are not eligible for review by HomVEE.

For more information, read the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

Triple P – Positive Parenting Program^® (Triple P) is a parenting and family support system that serves families with children from birth through age 16. The system includes multiple interventions that increase in intensity across five levels of service. Within each level, there is a range of delivery methods to meet different family needs and be appropriate for multiple cultures. Home visiting is one of the methods of delivering services within some levels.

No Triple P level or intervention is exclusively delivered in the home with families with children from birth through age 5. This profile is based on (1) studies of programs that provided Triple P services in the home to families with children from birth through age 5, and (2) developer input on the Triple P interventions suitable for delivery in the home with families with children from birth through age 5. HomVEE refers to the approach to delivering Triple P in the home with families with children birth through age 5 as Triple P–Variants suitable for home visiting*.

Triple P draws on social learning theory, cognitive behavioral development, and research on the risk factors associated with social and behavioral problems in children.

The system’s five levels are organized by the degree of parental need or child behavioral difficulties. Intensity ranges from Level 1, a population-wide communication strategy, to Level 5, which addresses issues that complicate parenting such as partner conflict, stress, mental illness, risk of child maltreatment, and anger management. Below is a brief description of each level, including whether home visiting can be used as a service delivery method.

• Levels 1 and 2 do not involve home visiting.
  • Level 1 is a community-wide communications strategy designed to promote the importance of parenting and raise awareness of parenting needs throughout a community.
  • Level 2 provides parents with minor concerns about their child’s behavior or development brief parenting advice through a one-time parenting seminar or consultation.
• Levels 3 through 5 can involve home visiting.
  • Level 3 provides narrowly focused parenting skills training targeting a specific behavioral problem or issue through face-to-face or telephone sessions with a practitioner or small group sessions. The Triple P interventions offered at this level include Primary Care Triple P and Triple P Discussion Groups.
  • Level 4 provides broadly focused parenting skills training. This level offers four interventions: (1) Group Triple P, involving group sessions and phone or home-based sessions; (2) Standard Triple P, involving individual counseling sessions for parents who require intensive support; (3) Triple P Online, a web-based curriculum; and (4) Self-Help Triple P, a self-help workbook with phone consultations.
  • Level 5 provides more intensive family interventions that support parents who face complex parenting issues. The Level 5 interventions include (1) Enhanced Triple P for parents experiencing partner conflict, stress, or mental health issues, and (2) Pathways Triple P, which provides behavioral strategies for parents at risk of child maltreatment. Parents must participate in a Level 4 intervention before or in conjunction with Enhanced or Pathways Triple P.

Implementing agencies select the intensity, intervention, and delivery setting that reflects their organization’s priorities and budgets. For example, agencies can implement multiple Triple P interventions across levels to reach an entire population or select a Triple P intervention designed for a particular parenting group or demographic.

The following Triple P interventions are suitable for delivery in the home: Primary Care Triple P (Level 3), Standard Triple P (Level 4), Enhanced Triple P (Level 5), and Pathways Triple P (also Level 5).

Triple P also includes five adaptations for certain subgroups: (1) Stepping Stones Triple P for families with children with a disability, (2) Family Transitions Triple P for families in which parents are going through separation or divorce and have concerns about their children’s behavior, (3) Indigenous Triple P for indigenous families with children from birth through age 12, (4) Group Lifestyle Triple P for families with parents concerned about their children’s overweight or obesity and activity level, and (5) Teen Triple P for parents of teenagers through age 16. Family Transitions Triple P, Indigenous Triple P, and some versions of Stepping Stones Triple P (described in Adaptations and Enhancements) also are suitable for delivery in the home.

*In this profile, when a description or requirement is specific to delivering Triple P in the home with families with children from birth through age 5, the profile specifies that, such as by saying: “when delivering Triple P in the home…”. Otherwise, if a description or requirement applies to Triple P interventions across all settings, service delivery methods, and target populations, the profile says “Triple P…”.

Triple P was developed by researchers at The University of Queensland’s Parenting and Family Support Centre in Australia. Triple P is licensed under Triple P International Pty Ltd (TPI), based in Brisbane, Australia. TPI publishes Triple P resources, supports implementation, and provides training and accreditation. TPI subsidiary offices operate in many countries. In the United States, Triple P America’s implementation consultants support local and state government agencies and community-based organizations through all stages of implementation, including planning, training, delivery, evaluation, and sustainability.

The consultants use the Triple P Implementation Framework to support organizations, and the practitioners they employ, adopting Triple P. The consultants help an organization implement Triple P within its specific context and community. Triple P implementation consultants also offer communication support to help organizations and practitioners reach parents.

The Triple P interventions that can be delivered in the home mainly serve families with children from birth through age 16 who experience behavioral and emotional problems. For the purposes of the HomVEE review, this profile is based on: (1) studies of programs that served families with children from birth through age 5, and (2) developer input on the Triple P interventions suitable for families with children from birth through age 5.

Triple P is designed to prevent and treat the behavioral and emotional problems of children and teenagers. The system aims to equip parents with the skills and confidence they need to manage family issues without ongoing support.

Regardless of the setting, service delivery method, or target population, all Triple P interventions teach parents strategies focused on developing positive relationships, attitudes, and conduct with children to improve behavioral problems. However, the type and intensity of services when delivering Triple P in the home vary based on the degree of parental need or child behavioral difficulties:

• Primary Care Triple P (Level 3) serves parents with children with mild or moderate behavioral difficulties. It provides parenting strategies via home visiting focused on a specific behavioral problem or issue, face to face or by telephone.

• Standard Triple P (Level 4) offers individual counseling to parents of children with more severe behavioral difficulties who need more intensive support. This intervention includes child management training, which shows parents how they can help teach their children new behaviors using strategies such as descriptive praise and contingent consequences. The practitioner provides verbal and written instruction and models behavior in an effort to teach parents steps intended to modify their child’s behavior. Then, the practitioner observes parent–child interactions and provides verbal feedback and written enrichment materials. It also includes planned activities training, which teaches parents planning strategies for managing children’s behavior in challenging situations and settings such as mealtimes or shopping trips.
• Enhanced Triple P (Level 5) includes up to four modules for parents that target specific concerns and seek to address partner relationships and communication, personal coping strategies for high-stress situations, and positive parenting practices.

• Pathways Triple P (Level 5) serves parents at risk of committing child maltreatment and covers anger management and other behavioral strategies to improve a parent’s ability to cope with raising children.

Session checklists outline the content the practitioners should deliver in each session.

The intensity and length of the Triple P interventions suitable for delivery in the home vary:

• Primary Care Triple P (Level 3)—approximately four consultations of 15 to 30 minutes each; 
• Standard Triple P (Level 4)—10 one-hour sessions; 
• Enhanced Triple P (Level 5)—approximately eight sessions, each lasting 60 to 90 minutes; and 
• Pathways Triple P (Level 5)—approximately five sessions, each lasting 60 to 90 minutes.

The recommended frequency of sessions is one per week.

Triple P can be tailored to different delivery settings, practitioners, and populations. Practitioners are trained to apply Triple P processes and strategies in different ways to a range of presenting behavioral and emotional problems and family circumstances.

In addition, three Triple P adaptations have versions suitable for delivery in the home with families with children from birth through age 5:

1. Stepping Stones Triple P is designed for parents with children with disabilities. It provides an assessment of parenting strategies and then instruction and support that aim to promote child competencies in social and language skills, emotional skills, independence, and problem solving. There are two versions of Stepping Stones suitable for delivery in the home with children from birth through age 5: Primary Care Stepping Stones (Level 3), which offers four individual consultations of 15 to 30 minutes each, and Standard Stepping Stones (Level 4), which offers 10 one-hour sessions.   
2. Family Transitions Triple P is designed for parents whose separation or divorce has complicated parenting. Practitioners help parents adjust to their separation or divorce, and to foster conflict resolution skills and stress management. The intervention includes weekly two-hour sessions for five weeks. Family Transitions Triple P is provided in addition to a Level 4 Triple P intervention. 
3. Indigenous Triple P is designed for indigenous families with children from birth through age 12. The intervention involves six sessions of individual home visits and telephone counseling sessions. 

Triple P can be implemented by various agencies. For example, health care or educational practitioners can deliver Triple P directly to their clients, and all levels of governments (county, council, state, or national) and tribal agencies at all levels can train workforces to deliver Triple P. Implementing agencies should have experience serving children and families, and should have the organizational capacity and structure to deliver the level of Triple P they plan to implement.

Triple P does not have fidelity standards other than practitioner accreditation requirements. Triple P implementation consultants can help sites develop fidelity monitoring plans that best suit site-specific needs and are aligned with the system’s evidence related to best practices.

TPI expects agencies to implement Triple P using their existing workforce. An agency can implement Triple P with a single practitioner. However, TPI recommends staffing Triple P with multiple practitioners so they can support one another and so the organization can better manage staff attrition. TPI recommends that agencies provide supervisory staff. Other relevant staff may include a program manager or coordinator to oversee program set-up and implementation.

Staff from a range of disciplines, including “promotores” (community health workers who work in Spanish-speaking communities) and other paraprofessionals, physicians, nurses, school counselors, teachers, psychologists, and social workers can deliver Triple P in the home with families with children from birth through age 5. For more intensive interventions, staff may have regular interaction with the families through their other professional duties in addition to home visits.

TPI recommends, but does not require, practitioners who deliver Triple P, have a postsecondary degree in health, education, child care, or social services. Practitioners without a postsecondary degree in the specified areas are eligible to be Triple P practitioners if they have experience working directly with the intended population to support child or adolescent development, and have adequate clinical supervision and regular support. For Standard Triple P (Level 4), it is desirable that practitioners have knowledge of child and adolescent development to undertake training. TPI recommends, but does not require, supervisors have familiarity with the Triple P system and a master’s degree or higher in education or clinical psychology.

TPI recommends, but does not require, Triple P practitioners be supervised by Triple P-trained supervisors. Triple P implementation consultants can help agencies develop supervision plans when it is not feasible for the agencies to employ supervisors trained in Triple P. Supervisors review clients’ records, engagement, outcomes, and satisfaction, and support practitioners’ participation in a peer support program. Agencies should also continue to provide their standard supervision practices.

Triple P recommends that practitioners participate in the manualized Peer Assisted Supervision and Support (PASS) program to reinforce the model’s self-regulatory approach. Triple P practitioners meet during PASS sessions to receive structured feedback from peers on their consultation skills. PASS sessions include case reviews, discussion of implementation issues, and professional development activities. The sessions should be scheduled frequently leading up to accreditation, after which sessions should take place every four to six weeks.

Triple P requires practitioners to participate in pre-service training. Pre-service training consists of one- to four-day workshops with videos, group discussions, and rehearsals. Practitioners must be trained in Standard Triple P before they are trained in Enhanced or Pathways Triple P. TPI recommends that supervisors observe Triple P training.  Practitioners must achieve accreditation by demonstrating their competency with the intervention. For a given Triple P intervention, training and accreditation requirements are the same across setting, service delivery method, or target population; however, training requirements differ across interventions. Please contact the model developer for more information about the pre-service training requirements.

Triple P does not have requirements that practitioners and/or supervisors participate in ongoing professional development.

Triple P America
P.O. Box 12755
Columbia, SC 29211

Phone: (803) 451-2278
Email: contact.us@triplep.net
Website: http://www.triplep.net