The Triple P System

Evidence Rating:

Near Top Tier

Highlights

Program:

A system of parenting programs for parents with children age 0-8.
Evaluation Methods:

A well-conducted randomized controlled trial (RCT) of the Triple P System as implemented community-wide in nine South Carolina counties.
Key Findings:

13-33% reductions in county-wide rates of child maltreatment, hospital visits for maltreatment injuries, and foster-care placements, two years after random assignment.
Other:

(i) These findings apply to the full Triple P System for families with children age 0-8 (as opposed to other versions of Triple P).

(ii) A study limitation is its relatively small and homogeneous sample – 18 South Carolina counties. Thus, replication of these findings in a second trial, in another setting, would be desirable to confirm the initial results and establish that they generalize to other settings where the System might be implemented.

The Triple P (Positive Parenting Program) System is a system of parenting programs for families with children ages 0-8, [1] which seeks to strengthen parenting skills and prevent dysfunctional parenting, so as to prevent child maltreatment and emotional, behavioral, and developmental problems. The System emphasizes five core principles of positive parenting: (i) ensuring a safe, engaging environment; (ii) promoting a positive learning environment; (iii) using assertive discipline; (iv) maintaining reasonable expectations; and (v) taking care of oneself as a parent.

System services include various combinations of parenting seminars, parent skills-training sessions, and individual consultations. These services are provided in one to ten or more sessions, with the type and amount of service (i.e., service “levels”) tailored to the severity of the family’s dysfunction and/or child’s behavioral problems. Sessions are delivered by a variety of service providers from different settings (e.g., healthcare, preschools, elementary schools, mental health, social services) who have completed Triple P’s 3-5 day training regimen. The System also includes media strategies promoting positive parenting practices community-wide (e.g., news stories, parenting articles, newsletters, radio announcements).

In the study described in our full evidence summary, the System trained approximately 650 existing service providers in nine counties to deliver Triple P county-wide for families with children ages 0-8. The cost of building a public health infrastructure to deliver the Triple P System on roughly this scale – including training and supporting the service providers, and implementing the media strategies – is about $2.6 million, or $14 per child age 0-8, in 2017 dollars. [2]

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

[1] Other versions of Triple P serve children up to age 12 and/or provide specific components (“levels”) of Triple P but not the full System (see discussion of service levels under “Description of the Program”).

[2] This is the cost estimate for a set of counties whose total population is about 15-20% larger than that of the nine Triple P counties participating in the study. This estimate is comprised primarily of one-time start-up costs, and does not include the ongoing cost to service providers of delivering the parenting programs. The magnitude of that ongoing cost depends on how easily the providers can incorporate Triple P activities into their regular routine, substituting for other activities.

Prinz, Ronald J., Matthew R. Sanders, Cheri J. Shapiro, Daniel J. Whitaker, and John R. Lutzker. “Addendum to: ‘Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial.’” Prevention Science, 2016, vol. 17, no. 4, pp. 410-416.

Prinz, Ronald J., Matthew R. Sanders, Cheri J. Shapiro, Daniel J. Whitaker, and John R. Lutzker. “Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial.” Prevention Science, 2009, vol. 10, no. 1, pp. 1-12.

Foster, E. Michael, Ronald J. Prinz, Matthew R. Sanders, and Cheri J. Shapiro. “The costs of public health infrastructure for delivering parenting and family support.” Children and Youth Services Review, 2008, vol. 30, pp. 493-501.

Highlights

Program:

Evaluation Methods:

Key Findings:

Other:

References

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