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Level 4 Group Triple P

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Evidence rating: 3+
Cost rating: 1

Level 4 Group Triple P is a targeted-indicated intervention for parents with a child between 0 and 12 years old who have concerns about their child’s behaviour.

Groups of up to 12 parents attend sessions over eight weeks delivered by a single trained and supervised clinical psychologist. These sessions include five two-hour group meetings, as well as three individual telephone consultations lasting 15 to 30 minutes.

Parents learn 17 different strategies for improving their children’s competencies and discouraging unwanted child behaviour. Role play, homework exercises and discussions involving video-taped examples of effective parenting strategies are used to help parents learn methods for dealing with unwanted child behaviour and supporting their child’s emotional needs.

EIF Programme Assessment

Evidence rating: 3+
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome. This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
Cost rating: 1
A rating of 1 indicates that a programme has a low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of less than €125. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Supporting children's mental health and wellbeing

Reduced emotional problems

based on study 1

  • Statement: 1.31-point improvement on the Strengths and Difficulties Questionnaire (Emotional Symptoms Scale)
  • Score: 23
  • Timeframe: Immediately after the intervention

Preventing crime, violence and antisocial behaviour

Reduced behaviour problems

based on study 1

  • Statement: 2.21-point improvement on the Parent Daily Report
  • Score: 21
  • Timeframe: Immediately after the intervention

Reduced frequency of disruptive behaviour

based on study 1

  • Statement: 8.82-point improvement on the Eyberg Child Behaviour Inventory (Problem Scale)
  • Score: 36
  • Timeframe: Immediately after the intervention

based on study 2

  • Statement: 4.47-point improvement on the Eyberg Child Behaviour Inventory (Problem Scale)
  • Score: 27
  • Timeframe: Immediately after the intervention

Reduced intensity of disruptive behaviour

based on study 1

  • Statement: 29.17-point improvement on the Eyberg Child Behaviour Inventory (Intensity Scale)
  • Score: 34
  • Timeframe: Immediately after the intervention

based on study 2

  • Statement: 9.89-point improvement on the Eyberg Child Behaviour Inventory (Intensity Scale)
  • Score: 17
  • Timeframe: Immediately after the intervention

Reduced conduct problems

based on study 1

  • Statement: 1.23-point improvement on the Strengths and Difficulties Questionnaire (Conduct Scale)
  • Score: 27
  • Timeframe: Immediately after the intervention

Reduced hyperactivity problems

based on study 1

  • Statement: 1.32-point improvement on the Strengths and Difficulties Questionnaire (Hyperactivity Scale)
  • Score: 23
  • Timeframe: Immediately after the intervention

Reduced peer problems

based on study 1

  • Statement: 1.07-point improvement on the Strengths and Difficulties Questionnaire (Peer Problem Scale)
  • Score: 24
  • Timeframe: Immediately after the intervention

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Infants Toddlers Preschool Primary school

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Group

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Children's centre or early-years setting
  • Primary school
  • Community centre
  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted indicated

Where has it been implemented?

  • Argentina
  • Australia
  • Belgium
  • Canada
  • England
  • France
  • Germany
  • Hong Kong
  • Ireland
  • Japan
  • Mexico
  • Netherlands
  • New Zealand
  • Romania
  • Scotland
  • Singapore
  • Sweden
  • Switzerland
  • United Kingdom
  • United States
  • Wales

Ireland provision

This programme has been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

  • Level 4 Group Triple P is delivered by a Triple P practitioner in five sessions of approximately two hours’ duration to groups of up to 12 families. An additional three sessions (between 15 and 30 minutes each) are delivered to individual families via telephone. 

What happens during the intervention?

  • Parents learn 17 different strategies for improving their children’s competencies and discouraging unwanted child behaviour.
  • Learning is supported through role play exercises, homework exercises and group discussions involving video-taped examples of effective parenting strategies.

What are the implementation requirements?

Who can deliver it?

  • The practitioner who delivers this programme is a Triple P practitioner, who can come from a range of professions (eg family support worker) with recommended minimum NFQ-6 level qualifications.


What are the training requirements?

The practitioner has three days of programme training. This includes one day of pre-accreditation, and a half-day accreditation workshop (accreditation workshops are held over two days; practitioners attend in groups of five). Booster training of practitioners is not required.


How are the practitioners supervised?

  • It is recommended that practitioners are supervised by one host-agency supervisor with NFQ-9/10 level qualifications, with no required programme training.


What are the systems for maintaining fidelity?

  • Accreditation process
  • Training manual 
  • Supervision
  • Fidelity monitoring

Is there a licensing requirement?

There is no licence required to run this programme.


How does it work? (Theory of Change)

How does it work?

  • Triple P is based on the idea that parents often unintentionally perpetuate unwanted child behaviour through ineffective parenting strategies.
  • Triple P helps parents replace ineffective parenting strategies with effective methods for encouraging positive child behaviour.
  • In the short term, parents learn more effective strategies for managing their child’s behaviour and the child’s behaviour improves.
  • In the longer term, children should have greater self-regulatory skills and self-confidence and do better in school.
  • It is also expected that children will be less likely to have behavioural problems and/or engage in antisocial behaviour.

Intended outcomes

  • Achieving in all areas of learning and development
  • Active and healthy, physical and mental wellbeing
  • Safe and protected from harm
  • Safe and protected from harm

Contact details

Matt Buttery
Triple P UK
matt.buttery@triplep.net

http://www.triplep.net/ 


About the evidence

Triple P (Level 4) Group’s most rigorous evidence comes from two RCTs which were conducted in Hong Kong. 

These studies identified statistically significant positive impact on a number of child and parent outcomes.

This programme has evidence from at least one rigorously conducted RCT along with evidence from an additional comparison group study.  Consequently, the programme receives a 3+ rating overall.

Study 1

Citation:Leung et al. (2003)
Design:RCT
Country:Hong Kong
Sample:91 middle-class families living in Hong Kong
Timing:Post-test
Child outcomes:
  • Reduced emotional problems
  • Reduced behaviour problems
  • Reduced frequency of disruptive behaviour
  • Reduced intensity of disruptive behaviour
  • Reduced conduct problems
  • Reduced hyperactivity problems
  • Reduced peer problems
Other outcomes:
  • Improved parenting
  • Increased self-efficacy
  • Improved relationship satisfaction
Study rating:3

Leung, 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.

Available at
https://www.ncbi.nlm.nih.gov/pubmed/14979223

Study design and sample

The first study is a rigorously conducted RCT.  

This study involved random assignment of children to a Triple P treatment group and a waitlist control group. 

This study was conducted in Hong Kong, with a sample of 91 middle-class families with a child between the ages of three and seven.

Measures

Child problem behaviours were measured using the Parent Daily Report (parent report). Child disruptive behaviours and intensity were measured using the Eyberg Child Behavior Checklist (parent report). Child prosocial and difficult behaviours were measured using the Strengths and Difficulties Questionnaire (parent report).

Parental dysfunctional discipline styles (laxness, overreactivity, verbosity) were measured using the Parenting Scale (parent report). Parental views of their competence as parents and satisfaction with their parenting role were measured using the Parenting Sense of Competence Scale (parent report). Conflict between partners over childrearing were measured using the Parent Problem Checklist (parent report). Relationship quality and satisfaction were measured using the Relationship Quality Index (parent report).

Findings

This study identified statistically significant positive impact on a number of child and parent outcomes.

Child outcomes include:

  • Reduced behaviour problems
  • Reduced frequency of disruptive behaviour
  • Reduced intensity of disruptive behaviour
  • Reduced conduct problems
  • Reduced hyperactivity problems
  • Reduced peer problems
  • Reduced emotional problems

Study 2

Citation:Chung et al. (2015)
Design:RCT
Country:Hong Kong
Sample:91 middle-class families living in Hong Kong
Timing:Post-test
Child outcomes:
  • Reduced frequency of disruptive behaviour
  • Reduced intensity of disruptive behaviour
Other outcomes:
    Study rating:3

    Chung, S., Leung, C., & Sanders, M. R. (2015). The Triple P – Positive Parenting Program: The effectiveness of group Triple P and brief parent discussion group in school settings in Hong Kong. Journal of Children’s Services, 10, 1-14.

    Available at
    http://www.emeraldinsight.com/doi/abs/10.1108/JCS-08-2014-0039

    Study design and sample

    The second study is a rigorously conducted RCT.  

    This study involved random assignment of children to a Triple P (Level 4) Group, Discussion Group Triple P (a different Triple P intervention), or a waitlist control group. 

    This study was conducted in Hong Kong, with a sample of  91 middle-class families with a child between the ages of three and seven.

    Measures

    Child disruptive behaviours and intensity were measured using the Eyberg Child Behavior Checklist (parent report). 

    Parental stress was measured using the Chinese Parental Stress Scale (parent report).

    Findings

    This study identified statistically significant positive impact on a number of child and parent outcomes.

    Child outcomes include:

    • Reduced frequency of disruptive behaviour
    • Reduced intensity of disruptive behaviour
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