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Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta‐Analysis

Authors:

Abstract

Triple P is a parenting program intended to prevent and to provide treatment for severe behavioral, emotional, and developmental problems in children. The aim of this meta-analysis was to assess the effectiveness of Triple P Level 4 interventions on parenting styles and parental competency. Level 4 is an intensive training program of 8 – 10 sessions for parents of children with more severe behavioral difficulties. The results indicated that the Triple P Level 4 interventions reduced dysfunctional parenting styles in parents and also improved parental competency. These effects were maintained well through time and appear to support the widespread adoption and implementation of Triple P Level 4 interventions that is taking place in an increasing number of countries around the world.
Effectiveness of the Triple P Positive Parenting Program
on Parenting: A Meta-Analysis
Ireen de Graaf Paula Speetjens Filip Smit Marianne de Wolff Louis Tavecchio*
Abstract: Triple P is a parenting program intended to prevent and to provide treatment for severe behavioral,
emotional, and developmental problems in children. The aim of this meta-analysis was to assess the effectiveness of
Triple P Level 4 interventions on parenting styles and parental competency. Level 4 is an intensive training program
of 8 – 10 sessions for parents of children with more severe behavioral difficulties. The results indicated that the Tri-
ple P Level 4 interventions reduced dysfunctional parenting styles in parents and also improved parental compe-
tency. These effects were maintained well through time and appear to support the widespread adoption and
implementation of Triple P Level 4 interventions that is taking place in an increasing number of countries around
the world.
Key Words: meta-analysis, parenting, parenting program, Triple P.
Family processes have a great influence on children’s
psychological, physical, social, and economic wel-
fare. Many significant mental health, social, and eco-
nomic problems are linked to disturbances in family
functioning (Chamberlain & Patterson, 1995; Pat-
terson, 1982; Sanders, Markie-Dadds, & Turner,
2003), and epidemiological studies have indicated
that poor parenting strongly influences how children
develop (e.g., Cummings & Davies, 1994; Dryfoos,
1990). The lack of a warm positive relationship with
parents; insecure attachment; harsh, inflexible, rigid,
or inconsistent discipline practices; and inadequate
supervision of and involvement with children are
specific factors that increase the risk that children
will develop major behavioral and emotional prob-
lems, including substance abuse, antisocial behavior,
and juvenile crime (e.g., Loeber & Farrington,
1998; Sanders et al., 2003); this implies that the
strengthening of parenting competences and
improvements in dysfunctional parenting styles
should have a positive impact on child well-being
and lead to a decrease in their behavioral problems.
Behavioral family interventions (BFI) that are
based on social learning principles are the most
extensively evaluated form of psychosocial interven-
tion for children and are effective in reducing family
risk factors associated with child behavior problems
(Kazdin, 1991; Patterson, Reid, & Dishion, 1992;
Webster-Stratton & Hammond, 1997). In fact,
studies demonstrating the efficacy of parenting inter-
ventions have shown improvements in parental
perceptions and parenting skills, improvements in
children’s social skills and school adjustment, and
reductions in behavioral and attention problems
(Barlow & Stewart-Brown, 2000; Taylor & Biglan,
1998). One widely used parenting intervention is
the Triple P—Positive Parenting Program, which
aims to equip parents more effectively for their
child-rearing role. The purpose of the present study
was to provide a meta-analytic review of the re-
search literature on the effectiveness of one level
of intervention of the Triple P parenting program
in improving parenting styles and parents’
competences.
*Ireen de Graaf, Trimbos Institute, The Netherlands Institute for Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands (igraaf@
Trimbos.nl). Paula Speetjens, Trimbos Institute, The Netherlands Institute for Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands
(pspeetjens@tirmbos.nl). Filip Smit, Trimbos Institute, The Netherlands Institute for Mental Health and Addiction, P.O. Box 3500 AS Utrecht, The Netherlands
(fsmit@Trimbos.nl). Marianne de Wolff, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, The Netherlands (marianne.dewolff@tno.nl). Louis Tavecchio,
University of Amsterdam, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands (L.W.C.Tavecchio@uva.nl).
Family Relations, 57 (December 2008), 553–566. Wiley Periodicals, Inc.
Copyright 2008 by the National Council on Family Relations.
A Publication of
the National Council on
Family Relations
The Triple P Positive Parenting
Program
Triple P, which designates a ‘‘positive parenting pro-
gram,’’ is a multilevel program designed to prevent
and offer treatment for severe behavioral, emotional,
and developmental problems in children from birth
to the age of 16 years, by means of enhancing the
knowledge, skills, and confidence of their parents.
The program was developed by Sanders and col-
leagues at the Parenting and Family Support Center
of the School of Psychology at the University of
Queensland (Sanders, Markie-Dadds, Tully, & Bor,
2000). Triple P incorporates five levels of interven-
tions on a continuum of increasing intensity of
behavioral and emotional problems in children.
Level 1 is a form of universal prevention that delivers
psychoeducational information on parenting skills to
interested parents. Level 2 is a brief intervention con-
sisting of one or two sessions for parents of children
with mild behavioral problems. Level 3 is a four-
session intervention that targets children with mild to
moderate behavioral difficulties and includes active
skills training for parents. Level 4 is described below.
Level 5, finally, is an enhanced BFI program for fam-
ilies where parenting difficulties are complicated by
other sources of family distress (Sanders et al., 2003).
Theoretical Basis of Triple P
Triple P aims to enhance family protective factors
and reduce risk factors associated with severe be-
havioral and emotional problems in children and
adolescents by using social learning models of parent-
child interaction that highlight the reciprocal and
bidirectional nature of these interactions (e.g., Patter-
son, 1982) and identify learning mechanisms that
maintain coercive and dysfunctional antisocial behav-
ior in children (Patterson et al., 1992). As a result,
the program teaches positive child management skills
to parents as an alternative to coercive, inadequate, or
ineffective parenting practices. These dysfunctional
parenting styles were the focus of our interest in con-
ducting this meta-analysis. According to these mod-
els, effective parents monitor their child’s behavior;
recognize deviant acts; and consistently use rewards,
punishment, and positive role model behaviors (Pat-
terson). This approach to the treatment and preven-
tion of childhood disorders has the strongest
empirical support of any intervention with children,
particularly those with conduct problems (Kazdin,
1987; Taylor & Biglan, 1998; Webster-Stratton &
Hammond, 1997). Triple P is a form of BFI, which
has clearly been shown to be beneficial in children
with disruptive behavior disorders (Forehand &
Long, 1988).
Furthermore, the Triple P program is based on
research in child and family behavior therapy that
has developed many useful behavior change strate-
gies, particularly research that focuses on rearranging
antecedents of problem behavior by designing more
positive, engaging environments for children (Risley,
Clark, & Cataldo, 1976). Congruent with the devel-
opmental research on parenting in everyday con-
texts, Triple P teaches parents to use naturally
occurring daily interactions to teach children lan-
guage, social skills, developmental competencies, and
problem-solving skills in an emotionally supportive
context. The important role of parental cognitions,
such as attributions, expectancies, and beliefs as fac-
tors that contribute to parental self-efficacy, decision-
making, and behavioral intentions, is highlighted by
social information processing models (e.g., Bandura,
1977, 1995). A central element in the program is the
development of parents’ capacity for self-regulation,
which involves teaching skills to parents that enable
them to become independent problem solvers. Self-
regulation is a process whereby individuals are taught
skills to modify their own behavior (Sanders et al.,
2003). In this study, we were interested in parental
self-efficacy, which is part of the self-regulatory
framework.
Characteristics of Triple P
Our focus here was on Level 4 interventions because
most of the relevant Triple P studies have encom-
passed this particularly level of the Triple P system.
The Level 4 intervention can be considered the core
intervention of Triple P. Research into this system
of BFI began with research into Level 4 interven-
tions, which target individual parents of children at
risk, or an entire population, in order to identify
individual children at risk. Parents are taught a vari-
ety of child management skills, including providing
brief, contingent attention following desirable
behavior; how to arrange engaging activities in high-
risk situations; and how to use clear calm instruc-
tions, logical consequences for misbehavior, planned
ignoring, quiet time (nonexclusionary time-out),
and time-out (Sanders et al., 2003).
Family Relations Volume 57, Number 5 December 2008554
The Level 4 interventions in Triple P can be
delivered in a variety of formats, including individual
face-to-face, group, telephone-assisted, self-directed
programs or a combination of these. Standard Triple
P is a face-to-face 10-session program for parents and
incorporates sessions dealing with the causes of child-
ren’s behavior problems, strategies for encouraging
children’s development, and strategies for managing
misbehavior; sessions last up to 90 min each. Group
Triple P is an eight-session program ideally con-
ducted in groups of 10 – 12 parents, which is appro-
priate as a universal (available to all parents) or
selective (available to targeted groups of parents) pre-
ventive parenting support strategy. The program
consists of four 2-hr group sessions, which provide
opportunities for parents to learn through observa-
tion, discussion, practice, and feedback. Self-Directed
Triple P is ideal for families where access to clinical
services is poor and consists of a 10-week Self-Help
program for parents, which may be augmented by
weekly 15- to 30-min telephone consultations.
Previous Evaluations of the Triple P Program
The intervention methods of Triple P have been sub-
jected since 1978 to a series of controlled evaluations
using both intrasubject replication designs and tradi-
tional randomized control group designs, and there is
evidence that Triple P is an effective parenting strategy
(Sanders et al., 2003). Several studies have shown that
the parenting skills training used in Triple P produced
a predictable decline in child behavior problems and
that this decline was generally maintained through
time (Sanders et al., 2003). Furthermore, clinically
meaningful and statistically reliable outcomes for both
children and their parents have been demonstrated for
the standard, self-directed, telephone-assisted group,
and enhanced interventions. The program has also
been successfully used for several different family
types, including two-parent families, single parents,
stepfamilies, maternally depressed families, and mari-
tally discordant families (Sanders et al., 2003).
Hypotheses
We hypothesized in these meta-analyses that dys-
functional parenting styles would improve and that
parents’ competences would increase after participat-
ing in Triple P Level 4 intervention—measured
directly after the intervention and at the follow-up
3 – 12 months later. The second hypothesis was that
the efficacy of Triple P depended on whether the
intervention was delivered to individual parents or
groups or in a Self-Help format. Program modality
might, in fact, have had an impact on the effects of
parenting because of the difference in the intensity
of the intervention (self-help vs. face to face) or the
degree of personal attention from the therapist (indi-
vidual or group). Third, we hypothesized that the
Triple P Level 4 intervention was more effective for
parents of children with higher scores on behavior
problems because of the greater responsiveness of
severely distressed parents who are coping with diffi-
culties in managing children. One study (Chamberlain
et al., 2007) found that specific parenting practices
mediated reductions in child behavior problems,
especially when high-risk children were involved.
The effects on parenting were most evident in fami-
lies where children had relatively high levels of initial
behavior problems. Our hypothesis, as a conse-
quence, was that the Triple P Level 4 intervention
was more effective in children with higher initial
scores on behavior problems, which led to the fur-
ther hypothesis that Triple P was more effective
when the interventions were given to parents of
young children (age 2 – 4) and to parents of boys.
The reason for this was that empirical studies have
shown that physically aggressive behavior occurs in
children of 1 year old, increases in the second life
year, and then tends to decline from the third birth-
day onward (Alink et al., 2006; Tremblay et al.,
2004); furthermore, it is also evident that boys
exhibit more externalizing problems than girls at the
age of 2 and 3 years (Alink et al.).
We conducted two meta-analyses. The first
meta-analysis assessed the effectiveness of Triple P
on parenting styles or competences of parents in the
experimental group compared with the control
group, as measured immediately at the end of the
intervention. The second meta-analysis assessed the
degree to which postintervention effects were main-
tained through time in the intervention group.
Meta-Analysis of Level 4
Interventions
Pertinent Studies
In this meta-analysis, we examined the effectiveness
of Triple P interventions on parenting by pooling
the evidence from the pertinent studies. The greater
Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis de Graaf et al. 555
number of participants in a meta-analysis means that
the results of a large and diverse body of studies can
be summarized, interpreted, and more readily gener-
alized to an entire population (Rosnow & Rosenthal,
2002). This present meta-analysis also calculated an
overall effect size for Level 4 Triple P interventions
worldwide. It was decided to restrict the meta-analysis
exclusively to Level 4 of the Triple P system because
most of the relevant Triple P studies that had been
identified related to Level 4 because of the fact that
initial research focused on this core intervention of
Triple P. An important reason for conducting a meta-
analysis was to summarize research findings in order
to process information from a large number of study
findings, and we analyzed the Level 4 intervention as
a consequence. Furthermore, the set of findings
included in a meta-analysis must result from compa-
rable interventions. Table 1 summarizes the studies
included in this analysis.
Inclusion Criteria
We used three different search methods to identify
literature for the meta-analysis. First of all, we
searched for literature in two electronic databases,
Medline 1975 – February 2006 and Psychinfo 1975 –
February 2006. The keywords used were ‘‘Triple P’’
and ‘‘parent,’’ so that words like parenting or paren-
tal were also included in the search. Second, we
searched all reference lists of studies compiled by the
Parenting and Family Support Centre at the Univer-
sity of Queensland in Australia. Third, we asked
researchers who had conducted Triple P studies
whether they had other relevant unpublished mate-
rial. Studies had to meet the following inclusion cri-
teria: (a) the study had to have examined the effects
on a Triple P Level 4 intervention, which is an
intensive parent training program for parents who
have children with more severe behavioral difficul-
ties; (b) the effectiveness of Triple P had to have
been assessed using a questionnaire for the parents
to evaluate parenting styles and parental competen-
ces; and (c) sufficient empirical data had to have
been reported to enable the calculation of standard-
ized effect sizes. Because we conducted two meta-
analyses, studies had to have reported posttest data
on the intervention group and on the control group
for the purposes of the first meta-analysis and pre-
data and follow-up data had to be reported sepa-
rately for the intervention group for the purposes of
the second meta-analysis.
Selected Studies
We found 48 effect studies in which all levels of
Triple P were used and 25 studies that focused on
the Level 4 intervention. Nineteen studies met the
inclusion criteria; three studies were excluded from
the first meta-analysis because they had no control
group, and three other studies were excluded because
they had not examined the effects on a Triple P
Level 4 intervention.
The studies were independently coded by two
researchers on design and sample characteristics,
delivery format of the Level 4 intervention of Triple
P, reliability and validity of the measures, character-
istics of the parents and children, the children’s initial
problems, and the length of follow-up times. Differ-
ences in the coding by the two researchers were
resolved by recalculation and consensus. Selected
characteristics of these 19 studies are included in
Table 1.
Sample Characteristics
Group Triple P was used as the intervention in
10 studies, Standard Triple P in four studies, and
Self-Directed Triple P in five studies. One study
(Sanders et al., 2000) compared two versions of Triple
P, the Self-Directed intervention and the Standard
Triple intervention, with a wait-list control group,
andweanalyzedbothinterventionsinthecaseofthis
study. Working parents were the target group of the
intervention in one study, 18 studies were randomized
clinical trials, and one study was a nonrandom, two-
group, concurrent, prospective, observation design
(Zubrick et al., 2005). The Triple P Level 4 interven-
tions, Standard, Group, or Self-Directed interventions
can be offered differently. The interventions some-
times targeted parents of high-risk children, and the
intervention was subject to strict entry criteria. In
other cases, however, Group Level 4 was administered
as a universal program targeting a high-risk area or
a geographical catchment area rather than to parents
of high-risk children themselves, with the consequence
that samples were often a mixture of parents of high-
risk and low-risk children.
This meta-analysis also included five studies in
which parents rated their children as being within
the clinical range on the Eyberg Child Behavior
Checklist (ECBI; Eyberg & Ross, 1978), and one
study involving parents of children with attention def-
icit hyperactivity disorder diagnosed by a pediatrician
Family Relations Volume 57, Number 5 December 2008556
Table 1. Selected Characteristics of Studies Examining the Effects of Triple P Level 4 Intervention on Parenting Styles and Parents’ Competency
Study Conditions: NTarget Population Measurement % DO Age Child (M) % boys Child beh. pr.
Bodenmann et al.
(2008)
Group: 51; No Treat-
ment: 41; Couples
Coping Enhancement
Tr.: —
Universally offered sample
in rural areas; parents
reported beh. pr. in
their children;
Switzerland
Pre-Post; 6 – 12
months;
PS-PSOC
12 at FU 6.60 (SD ¼2.83) 55 Nonclinical
Connell, Sanders,
and Markie-
Dadds (1997)
Self-Directed: 12;
Waitlist: 11
Children rated in the
clinical range on the
ECBI; Australia
Pre-Post; 4
months;
PS-PSOC
4.27 (SD ¼1.05) 43 Clinical
Gallart and
Matthey (2005)
Group: 33; Waitlist: 16 Universally offered sam-
ple; parents reported
beh. pr. in their chil-
dren; Australia
Pre-Post; PS 5.40 (SD ¼1.5) 75 Nonclinical
Heinrichs et al.
(2005)
Group: 129; Waitlist: 94 Universally offered sam-
ple, all families in child
care in catchment area;
Germany
Pre-Post; 12
months; PS
4.00 (SD ¼0.98) 54 Nonclinical
Hoath and
Sanders (2002)
Group: 9; Waitlist: 11 Families with a child with
a clinical diagnosis of
attention deficit hyper-
activity disorder;
Australia
Pre-Post; 3
months; PS
5 at post;
23 at FU
7.70 (SD ¼1.33) — Clinical
Ireland, Sanders,
and Markie-
Dadds (2003)
Group: 16; Enhanced
Group: 16
Universally offered sam-
ple, parents reported
beh. pr. in their chil-
dren; Australia
Pre-Post; 3
months; PS
28 at FU 3.53 (SD ¼1.12) 58 Nonclinical
Leung, Sanders,
Leung, Mak,
and Lau (2003)
Group: 33; Waitlist: 36 Universally offered sam-
ple; parents reported
beh. pr. in their chil-
dren; Hong Kong
Pre-Post;
PS – PSOC
24 at post 4.23 (SD ¼1.06) 64 Clinical
(Continued )
Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis de Graaf et al. 557
Table 1. Continued
Study Conditions: NTarget Population Measurement % DO Age Child (M) % boys Child beh. pr.
Markie-Dadds and
Sanders (2006a)
Self-Directed: 21;
Waitlist: 22
Children rated in the
clinical range on the
ECBI: Australia
Pre-Post; 6
months;
PS – PSOC
3.59 (SD ¼0.76) 64 Clinical
Markie-Dadds and
Sanders
(2006b)
Self-Directed: 28;
Waitlist: 12
Children rated in the
clinical range on the
ECBI: Australia
Pre-Post; 6
months;
PS – PSOC
0 at post; 4
at FU
3.89 (SD ¼0.96) 64 Clinical
McTaggart and
Sanders (2003)
Group: 79;
Waitlist: 244
Universally offered sam-
ple, all families living
in a high-risk area;
Australia
Pre-Post; 6
months;
PS – PSOC
14 at post 57 Nonclinical
Morawska and
Sanders (2006)
Self-Directed: 73;
Waitlist: 37
Universally offered sam-
ple; parents reported
beh. pr. in their chil-
dren; Australia
Pre-Post; 6
months; PS
11 at post 2.18 (SD ¼0.42) 51 Nonclinical
Plant and Sanders
(2007)
Stepping Stones: 24;
Stepping Stones: —;
Enhanced: 26;
Waitlist: 24
Parents of children with
diagnosed developmen-
tal disability; Australia
Pre-Post; 12
months;
PS – PSOC
0 at post;
5.5 at
FU
4.56 (SD ¼1.13) 76 Clinical
Roberts, Mazzuc-
chelli, Studman,
and Sanders
(2006)
Stepping Stones: 17;
Waitlist: 15
Parents of children with
a diagnosed develop-
mental disability:
Australia
Pre-Post; 6
months; PS
33 at post;
44 at FU
4.30 (SD ¼1) 57 Clinical
Sanders et al.
(2000)a
Standard: 65; Self-
Directed: 61;
Enhanced: 58;
Waitlist: 71
Children rated in the clin-
ical range on the ECBI:
Australia
Pre-Post; 12
months;
PS-PSOC
14 at post 3.40 (SD ¼0.30) 68 Clinical
Sanders and
McFarland
(2000)
Behavioral Family
Intervention: 24;
Cognitive Behavioral
Intervention: 23
Children rated in the clin-
ical range on the ECBI,
mothers with major
depression: Australia
Pre-Post; 6
months;
PSOC
21 at post 4.39 (SD not
reported)
74 Clinical
Stallman, Ralph,
and Sanders
(2005)
Self-Directed 1Tel.: 17;
Self-Directed: 18;
Waitlist: 16
Universally offered sam-
ple; parents reported
beh. pr. in their chil-
dren: Australia
Pre-Post; 3
months; PS
11.8 at
post;
23.5 at
FU
12.3 (SD ¼0.54) 59 Nonclinical
Family Relations Volume 57, Number 5 December 2008558
or mental health professional. The clinical cutoff
score for the ECBI Intensity Scale was 127 and was
11 for the ECBI Problem Scale (Eyberg & Ross).
In the remaining 13 studies, children were not
rated as being in the clinical range of behavior prob-
lems; the children in two of these studies had a de-
velopmental disability, the parents in eight studies
reported concerns about their child’s behavior, and
the targeted populations in three studies were all the
families in a high-risk area. It should be noted in this
context that self-regulation is an important concept
in Triple P, which means that parents play an
important role in deciding the level of intervention
they wish to participate in and no rigid inclusion or
exclusion criteria are applied. In 10 of the studies
selected for this meta-analysis, parents reported their
child’s behavior as being in the clinically elevated
range at preassessment; in nine of the studies, the
children’s behavior was reported as being in the non-
clinical range. Children were in the clinical range at
pretest in one universally offered intervention, which
was a study among indigenous people (Turner,
Richards, & Sanders, 2007). Higher problem scores
in children at preassessment probably result in a
higher positive change in behavioral problems at post-
assessment. One study was conducted in Germany,
one in Hong Kong, and one in Switzerland; 16
studies were conducted in Australia. The percent-
age of boys was 68.3% averaged across all studies,
and we divided the studies into those with less than
68.3% boys and those with more than 68.3% boys,
in order to have two comparable groups. Boys were
overrepresented in all studies, and the studies
would have been heterogeneous if we had divided
the groups into 50% boys and 50% girls. The chil-
dren were younger than 4 years old in six studies. A
total of 17 studies that were based on the Parenting
Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993)
and eight studies that were that were based on the
Parenting Sense Of Competence Scale (PSOC;
Gibaud-Wallston & Wandersman, 1978) were
selected for the meta-analyses; both measurements
were used in eight studies. Seventeen studies that
were based on the PS were selected for the first
meta-analysis and nine studies that were based on
the PSOC. Sixteen PS-based studies were selected
for the second meta-analysis and eight PSOC-based
studies. Follow-up data were presented in 17 stud-
ies, and follow-up measurements were taken at
both 6 and 12 months in one study (Bodenmann,
Cina, Ledermann, & Sanders, 2008).
Turner et al.
(2007)
Group: 18; Waitlist: 18 Universally offered sample
of indigenous families;
parents reported beh.
pr. in their children;
Australia
Pre-Post; 6
months; PS
22 at post;
26 at FU
5.72 (SD ¼3.19) 67 Clinical
Yuki Matsumoto,
Sofronoff, and
Sanders (2007)
Group: 23; Waitlist: 25 Universally offered sam-
ple; Japanese parents
reported beh. pr. in
their children; Australia
Pre-Post; 3
months; PS
0 at post; 4
at FU
4.90 (SD not
reported)
54 Nonclinical
Zubrick et al.
(2005)
Group: 691; Control
region: 774
Universally offered sam-
ple, all families in high-
risk area; Australia
Pre-Post; 12 – 24
months; PS
12 at post;
13 at 12
months;
21 at 24
months
3.73 (SD ¼1.17) 57 Nonclinical
Note. ECBI ¼Eyberg Child Behavior Checklist; Age Child (M)¼average age; beh.pr. ¼behavior problems; DO ¼percentage of dropout; FU ¼Follow-up; PS ¼Parenting Scale; PSOC ¼Parenting Sense of Competency Scale.
aAnalyses were conducted for both Standard Triple P and Self-Help Triple P in this study.
Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis de Graaf et al. 559
Sample Size
The size of the samples used for experimental and
control groups varied widely between 9 and 691 in
the 19 studies reviewed. Of the 43 samples reported
(i.e., 24 experimental groups, 19 control groups),
58% of them can be categorized as being relatively
small in size (e.g., n¼1 – 29), 41% as being mod-
erate in size (e.g., n¼30 – 59), and the remaining
26% as being large in size (e.g., n¼60 – 691).
These numbers are the reported sample sizes, when
the studies began. The percentage of dropout at
postmeasurement or follow-up time was 5 – 44%.
Measurement of Outcomes
The PS or the PSOC was used to assess the parent-
ing styles and competences of the parents. The PS is
a 30-item measure of parental perceptions of dys-
functional discipline styles in parents, which yields
a total score that is based on three factors: laxness,
overreactivity, and verbosity. The items on laxness
describe ways in which parents give in, allow rules to
go unenforced, or provide positive consequences for
misbehavior; the items on overreactivity reflect
parental mistakes such as displays of anger, mean-
ness, and irritability; the items on verbosity reflect
lengthy verbal responses and a reliance on talking,
even when talking is ineffective. Statements were
rated on 7-point Likert scales, with higher scores
indicating higher levels of parental dysfunction. The
scale had adequate internal consistency for the total
score (a¼.84), laxness (a¼.83), overreactivity
(a¼.82), and verbosity (a¼.63) scales and had
good test-retest reliability (r¼.84, .83, .82, and .79,
respectively; Arnold et al., 1993).
The PSOC is a 16-item questionnaire used to
assess parents’ views of their competence as parents on
two dimensions: (a) satisfaction with their parenting
role, which reflects the extent of parental frustration,
anxiety, and motivation and (b) feelings of efficacy as
a parent, which reflect competence, problem-solving
ability, and capability in the parenting role. Parents
are asked to respond to a series of statements about
parenting by indicating their agreement or disagree-
mentandeachitemismeasuredona7-pointLikert
scale, ranging from 1 (strongly disagree)to7(strongly
agree). The total score (16 items), Satisfaction factor
(nine items), and Efficacy factor (seven items) showed
a satisfactory level of internal consistency (a¼.79,
.75, and .76 respectively; Johnston & Mash, 1989).
Methodological Analysis
An effect size (i.e., the standardized difference
between the means of two groups; Cohen’s d) was
calculated for each study. In the first meta-analysis,
we were interested in the differences between mean
scores in the experimental group and in the control
group at postmeasurement. The standardized effect
size, d, was calculated as d¼(M
E
2M
C
/SD
C
),
where M
E
and M
C
were the means of the experi-
mental and control groups at postintervention and
postmeasurement, respectively, and SD
C
was the
standard deviation of the control group. These stan-
dardized effect sizes, d, indicated how many stan-
dard units (zscores) the experimental group had
progressed at postmeasurement as compared with
the control group. In the second meta-analysis, we
also calculated the standardized mean difference as
d¼(M
P
2M
F
)/SD
P
, where M
P
and M
F
were the
means of the experimental group at baseline and
follow-up, respectively, and SD
P
was the standard
deviation at baseline of the experimental group. This
in-group effect size thus indicated the number of
standard units by which the recipients of the inter-
vention had improved over time relative to their
own baseline scores and can be interpreted, there-
fore, as a standardized health gain score. For exam-
ple, an effect size of d¼0.5 indicated that the mean
of the experimental group at follow-up assessment
was half a standard deviation larger than the mean
of the experimental group at baseline. The study by
Zubrick et al. (2005) was not a randomized clinical
trial, and so we calculated the standardized pre-post
change score for the experimental group (d
E
) and
did the same for the control group (d
C
). We subse-
quently calculated the difference using the following
formula: D(d)¼d
E
2d
C.
The meta-analyses were conducted using Meta-
Analysis, version 5.3 (Schwarzer, 1989), which is
based on the statistical techniques outlined by
Hedges and Olkin (1985); the results are shown in
Tables 2 and 3. An effect size in the range of d¼
0.56 – 1.2 may be interpreted as a large effect from
a clinical perspective, whereas effect sizes of 0.33 –
0.55 are moderate and effect sizes of 0.00 – 0.32
are considered small (Lipsey & Wilson, 1993). We
also conducted the Qtest for homogeneity, in
order to ascertain whether the various effect sizes
that were averaged into the pooled dvalues all esti-
mated the same population effect size (Rosenthal &
Rubin, 1982), followed by an outlier analysis
Family Relations Volume 57, Number 5 December 2008560
whenever the Qtest for homogeneity was signifi-
cant. In order to identify outliers, we conducted
cluster analyses (Schwarzer), conducted another
meta-analysis without the outlier, and then ascer-
tained whether we had obtained a more homoge-
neous set of primary studies in which the Qtest
was no longer significant.
We also formed subgroups on the basis of the
characteristics of the intervention. This was done in
order to ascertain whether a Self-Help version of Tri-
ple P was inferior (or superior) to a therapist-assisted
version. This contrast was considered to be statistically
significant when the 95% confidence intervals (CI) of
the respective effect sizes dwere not overlapping.
Results on Parenting Styles and Parental
Competences
Parenting styles. The overall mean effect size for
the 17 studies of parenting styles was 0.68 at post-
measurement, with a 95% CI of 0.48 – 0.87
(Table 2), which is a large effect according to
Cohen’s criteria and is statistically significant (Z¼
6.73, p,.001). However, the Qtest for the hypo-
thesis of homogeneity across effect sizes had to be
rejected, indicating that there was a substantial
amount of unexplained variance in the total set of
studies that might be attributable to the systematic
effects of covariates. Random sample error caused
48.9% of the variance, leaving 51.1% remaining,
which may have systematically covaried with
(unknown) covariates. The number of studies with
a zero effect that would have to be found in order to
reduce the effect size to 0.20 was 40.5.
The overall mean effect size relating to the long-
term measurement of parenting styles was d¼0.80,
with a 95% CI of 0.51 – 1.10, which is a large and
statistically significant effect (Z¼5.40, p,.001).
Again, the Qtest for the hypothesis of homogeneity
across effect sizes had to be rejected, random sample
error having caused 33.6% of the variance. The num-
ber of studies with a zero effect that would have to be
found in order to reduce the effect size to 0.20 is 51.4.
An outlier analysis was conducted for the set of
17 PS-based studies in which a pre-post design was
adopted and four clusters were found at a 5% confi-
dence level. When the question of why four studies
in three clusters differed from the other 13 studies
was examined, very large effect sizes were found in
two studies, the third study was the first study of
Self-Help Triple P, and the fourth study was
a mixture of Standard and Enhanced Stepping
Stones, which is an adaptation of Triple P for fami-
lies of children with developmental disabilities. An
analysis was made of one cluster that included five
studies of Self-Help, seven of Group Triple P, and
one study of Stepping Stones Triple P (13 studies).
An overall mean effect size of 0.54 was found, which
is a moderate effect (95% CI: 0.46 – 0.62, Z¼
13.44, p,.001); the Qtest indicated that this was
a homogeneous set of studies. The same outliers
were also excluded from the follow-up meta-analysis,
which found an overall mean effect size of 0.51,
which is a moderate effect (95% CI: 0.43 – 0.59,
Z¼12.55, p,.001); again, the Qtest indicated
that this was a homogeneous set of studies. In sum-
mary, the moderate effect sizes for a homogeneous
set of studies demonstrated that parenting styles of
parents who followed a Level 4 intervention of Tri-
ple P had improved at postmeasurement and follow-
up measurement.
Parental competencies. The overall mean effect
size for the eight studies of the parenting competen-
ces was 0.65 at postmeasurement with a CI of 0.36 –
0.94 (Table 2), which is a large effect according to
Cohen’s criteria and statistically significant (Z¼
4.32, p,.001). The Qtest for the hypothesis of
homogeneity across effect sizes had to be rejected,
41.85% of the variance having been caused by ran-
dom sample error. The number of studies with a zero
effect that would have to be found in order to reduce
the effect size to 0.20 was 18.1. The overall mean
effect size on long-term measurement of parenting
competences was d¼0.67 with a 95% CI of 0.43 –
0.89, which is a large and statistically significant
effect (Z¼5.76, p,.001). The Qtest indicated
that this was a homogeneous set of studies. Follow-
up at 6 months found an overall mean effect size of
d¼0.74, but the result was significantly heteroge-
neous. A meta-analysis of the three studies with a 12-
month follow-up discovered an overall mean effect
size of d¼0.58, and the Qtest indicated that this
was a homogeneous set of studies. In summary, the
findings for a homogenous set of studies indicated
that parental competencies had improved at postas-
sessment (moderate effects), had improved further at
follow-up assessment (large effect), and had been
maintained 1 year later (moderate effect).
Outlier analyses were also conducted for the
PSOC-based studies. One study with a very large
effect size was again excluded at postassessment, as was
a study with a very low effect size. An overall effect size
Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis de Graaf et al. 561
of 0.57 was found, which is a moderate effect (95%
CI: 0.38 – 0.77, Z¼5.84, p¼.00) and the Qtest
indicated that this was a homogeneous set of studies.
We conducted several additional meta-analyses
in order to examine whether effects were moder-
ated by the age of the children (i.e., younger vs.
older than 4 years), the gender of the children
(more or less than 68.3% boys), self-directed versus
practitioner-assisted intervention, and the behavior
problems scores of the children on the ECBI, the
Strengths and Difficulties Questionnaire, or the
Child Behavior Checklist (scoring problems at pre-
test in clinical range vs. nonclinical range). The
outliers were excluded once more by cluster analy-
ses using the computer program (Schwarzer, 1989),
and the results are summarized in Table 3. Studies
with more than 68.3% boys were found to show
significantly greater long-term effects on parenting
styles and parental competency measured with the
PSOC (d¼0.50: 95% CI 0.31 – 0.69 vs. d¼
1.20; CI 0.76 – 1.63). None of the other modera-
tor variables were significant.
Summary and Discussion
Although family relationships are important, parents
generally receive little preparation for their parenting
role and most of them learn ‘‘on the job,’’ by trial
and error (Risley et al., 1976; Sanders et al., 2000).
The importance of parenting programs in improving
parenting skills with the objective of reducing family
risk factors associated with child behavior problems
led us to conduct a meta-analysis to summarize the
findings for Level 4 interventions of the widely used
Triple P parenting program. We will now return to
the hypotheses set out at the beginning of this article
and highlight some implications for research, policy,
and practice.
Did the Parenting Styles of Parents Improve After
Participating in a Triple P Level 4 Intervention?
Improving parenting styles can have a positive
impact on reducing childhood disorders. We
Table 2. Results of Meta-Analyses Examining the Effects of the Triple P Level 4 on the Parenting Scale (PS) and the
Parenting Sense of Competency Scale (PSOC)
Effects at Postmeasurement N
ES
ND95% CI Q(df )%SE F/S-K
PS
All studies 17 2,881 0.68 0.48 –0.87 40.63 (16)** 48.9 40.5
Outliers excluded
(nos. 2, 7, 13, 18, Table 1)
13 2,712 0.54 0.46 – 0.62 12.79 (12) 100 22
PSOC
All studies 8 857 0.65 0.36 – 0.94 31.32 (7)*** 41.85 18.1
Outliers excluded
(nos. 8, 12, Table 1)
6 460 0.57 0.38 – 0.77 7.76 (5) 100 11.2
Effects after 3 – 12 months
PS
All studies (3 – 12 months) 17 2,564 0.80 0.51 – 1.10 43.71 (16)** 33.6 51.4
All studies,
outliers excluded (nos. 2, 13, 18, Table 1)
14 2,480 0.51 0.43 – 0.59 12.09 (13) 100 21.9
4 – 6 months 12 652 0.96 0.57 – 1.35 26.57 (11)** 36.05 45.6
4 – 6 months
outliers excluded (nos. 2, 13, 18, Table 1)
9 568 0.67 0.50 – 0.84 2.18 (8) 100 21.3
Effects after 12 months 5 1,912 0.47 0.38 – 0.56 5.5 (4) 100 6.7
PSOC
All studies (3 – 12 months) 8 794 0.67 0.43 – 0.89 12.47 (7) 53.42 18.7
6 months 5 398 0.74 0.38 – 1.10 10.77 (4)*44.23 13.5
12 months 3 396 0.58 0.38 – 0.79 1.36 (2) 100 5.8
Note.N
ES
¼Number of effect sizes; N¼number of subjects in the studies; D¼overall effect size; % SE ¼percentage of the variance accounted for by random sample error;
Q¼Homogeneity Q;F/S-K ¼Orwin’s Fail-safe N.
*p,.05. **p,.01. ***p,.001.
Family Relations Volume 57, Number 5 December 2008562
concluded that dysfunctional parenting styles (lax-
ness, overreactivity, and verbosity) decreased signifi-
cantly immediately after the Triple P Level 4
intervention and that these results were maintained
for 3 – 12 months. The lack of extended follow-up
research unfortunately meant that less could be con-
cluded about longer term effects.
Did the Parental Competences Improve After
Participating in a Triple P Level 4 Intervention?
The educative approach to promoting parental com-
petence in Triple P views the development of a par-
ent’s capacity for self-regulation as a central skill.
This meta-analysis found positive effects on parental
satisfaction with their parenting role and feelings of
efficacy as a parent directly after the Triple P Level 4
intervention, and that these effects were maintained
for 3 – 12 months. These results indicate that par-
ents had more positive expectations about the possi-
bility of change, and we hypothesized that the more
self-sufficient parents become, the more likely they
are to be resilient in coping with adversity, seeking
appropriate support, and advocating for their chil-
dren (Sanders et al., 2003). The lack of extended
follow-up research again meant that less can be con-
cluded about longer term effects.
Are Some Modalities of the Triple P Level 4
Interventions More Effective on Parenting Styles and
Parental Competences Than Others?
The effects of the Triple P Level 4 interventions
were independent of whether the intervention was
delivered in an Individual, Group, or Self-Help for-
mat; self-directed and therapist-assisted intervention
were equally effective. Parents may have different
needs and preferences regarding the type and mode
of assistance they require, denoting a flexibility that
enables practitioners to determine the scope of the
intervention within their own service priorities
and funding (Sanders et al., 2003). Furthermore,
Table 3. Results of Meta-Analyses of Triple P Across Modalities on the Parenting Scale (PS) and the Parenting Sense of
Competency Scale (PSOC), at Follow-up Assessment
N
ES
ND95% CI Q%SE F/S-K
PS
Age ,4 years 5 1,732 0.50 0.41 – 0.60 9.02 100 7.62
Age .4 years 9 749 0.53 0.39 – 0.68 2.98 100 14.99
,68.3% boys 9 2,312 0.50 0.42 – 0.58 10.07 100 13.45
.68.3% boys 5 168 0.72 0.40 – 1.03 0.24 100 13.01
Initial nonclinical
behavior problems
8 2,096 0.47 0.39 – 0.56 6.89 100 11.00
Initial clinical
behavior problems
6 384 0.73 0.52 – 0.94 0.24 100 15.91
Self-directed 6 354 0.88 0.28 – 1.49 6.67 32.25 20.49
Therapist assisted 10 2,140 0.48 0.40 – 0.57 9.61 100 14.19
PSOC
All studies ,4 years 3 296 0.64 0.41 – 0.88 1.55 100 6.64
All studies .4 years 3 256 0.72 0.06 – 1.38 10.00** 16.34 7.79
,68.3% boys 4 434 0.50 0.31 – 0.69 0.75 100 6.01
.68.3% boys 2 118 1.20 0.76 – 1.63 1.20 83.54 9.96
Initial nonclinical
behavior problems
2 192 0.41 0.12 – 0.69 0.01 100 2.08
Initial clinical
behavior problems
4 380 0.67 0.47 – 0.88 1.85 100 9.47
Self-directed 3 180 0.58 0.28 – 0.88 2.56 100 5.76
Therapist assisted 4 372 0.72 0.26 – 1.18 10.31*22.50 10.39
Note.N
ES
¼Number of effect sizes; N¼number of subjects in the studies; D¼overall effect size; % SE ¼percentage of the variance accounted for by random sample error;
Q¼Homogeneity Q;F/S-K ¼Orwin’s Fail-safe N.
*p,.05. **p,.01.
Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis de Graaf et al. 563
self-directed support may lessen the need for many
parents to consult with practitioners (Rosen, 1976),
thereby reducing social service dependency.
What Is the Impact of Child Variables on the Effects
on Parenting Styles and Parental Competences?
The Triple P Level 4 intervention was not found to
be more effective on parenting styles and parental
competences in parents of children with behavior
problems rated in the clinical range as compared
with children with problems rated as nonclinical.
This meant that the Triple P Level 4 intervention
was effective across a diverse set of families with con-
cerns about their child’s disruptive behavior. Studies
with a higher proportion of boys (68.3%) showed
greater long-term effect sizes on parental competen-
ces than studies with fewer boys, which means that
the intervention was more effective for parents of
boys than for parents of girls; this is possibly because
of a higher level of problem behavior in boys. More
parents of boys than parents of girls were included
in the studies selected for this meta-analysis, and the
impact of gender on parental competences therefore
has to be clarified in future studies by including
more parents of girls. In addition, the age of the
children had no impact on parenting styles and
parental competences. These results indicate that the
Triple P Level 4 interventions are appropriate for
parents of children of different ages.
Implications
Implications for Research
The present meta-analysis has several limitations.
First of all, the number of participants was small in
several studies (fewer than 50 respondents were
included in 52.6% of the randomized studies). Sec-
ond, different studies were sometimes used in the
long-term analysis than were used in the postinter-
vention analysis; therefore, a longitudinal compari-
son of those effect sizes must be conducted with
caution. Third, we took the child as the unit of anal-
ysis in this meta-analysis because mothers and
fathers report about the same child; it would be
interesting, however, to analyze both parents sepa-
rately to find out whether they report differently.
Fourth, nine effect studies were not included in this
meta-analysis because strict methodological criteria
for inclusion were applied. This meta-analysis guar-
antees that the synthesis was based on the best evi-
dence alone, but its results may summarize only
a narrow research domain. The limitations explained
above mean that further research is necessary.
It may be useful to conduct more meta-analyses
on all instruments and data in the studies of Triple
P to provide us with more insight into the effects of
Triple P on differences between mothers and fathers
or into the impact of Triple P on parental mental
health. We are also interested in the differences in
effect sizes for the different delivery formats, and it
would be worthwhile to conduct meta-analyses of
the other levels of Triple P as well. A second direc-
tion for future research is to conduct more in-depth
analyses on the influences of the child moderators,
such as the age and gender of the children. It would
be interesting to analyze studies that included more
girls, in order to find out what the effects are on par-
ents of girls. Third, we recommend conducting
meta-analyses with parent moderators, such as the
parents’ age, gender, or education, if the data are
available. A fourth recommendation for future
research is to focus more on parents with children
with emotional problems rather than behavioral
problems. Finally, it would be interesting to examine
whether the maintained effects observed up to 12
months postintervention occur over a longer period
carrying over into the children’s adolescence.
Implications for Policy and Practice
The positive results in the meta-analyses and the
need for evidence-based programs worldwide imply
that it would be interesting for policymakers in
other countries to adopt the Triple P Level 4 inter-
ventions. The fact that parents are so vital to the
development of children within the family is cur-
rently placing increasing emphasis on providing
support, guidance, and treatment services to adults
who face parenting problems.
This study found moderate to large effects for the
Self-Help Triple P intervention. Self-Help interven-
tions have become more prevalent in the past two
decades (Glasgow & Rosen, 1978), and written
materials have several advantages over traditional
clinical services—they are convenient, they enable
users to repeat lessons, and they can be disseminated
to many people (Starker, 1990). With the future in
mind, parents might be able to follow the Self-Help
program while receiving telephone or e-mail support
Family Relations Volume 57, Number 5 December 2008564
from a practitioner. Parents are not always content
with their contacts with practitioners, and may,
therefore, prefer to try a Self-Help course, which
provides telephone or e-mail support; however, it is
important for parents to able to continue using serv-
ices within an agency if they need these after com-
pleting Self-Help Triple P. Preconditions for given
access to the program are that parents must not be
intellectually disabled and must report that they can
read fluently.
The analyses involved both universal prevention
samples and high-risk samples, and the effect sizes
were consequently very large for a public health
intervention that is universally offered. This means
that the interventions are applicable in the preven-
tion departments of public health institutions or
youth care departments, or both, and can be offered
by a range of different professionals, such as pedia-
tricians, teachers, social workers, psychologists, and
psychiatrists.
Conclusions
This meta-analysis was conducted to assess the effec-
tiveness of Level 4 of the Triple P multilevel inter-
vention system on parenting styles and parental
competences across different target groups and inter-
vention modalities. We were interested in the pooled
effect size of the measurements of parenting directly
after the intervention and between 3 and 12 months
later. Research findings from Triple P Level 4 inter-
ventions were summarized in this meta-analysis so
that the results could be more readily generalized for
a larger population. Statistical tests for homogeneity
were carried out to determine whether a grouping of
effect sizes from different studies showed more varia-
tion than would be expected from sampling error
alone; this procedure provided an empirical test of
whether or not it is plausible to presume that stud-
ies, which showed such disparate results, are compa-
rable. In addition, the systematic coding of study
characteristics, which is standard feature of a meta-
analysis, permitted an analytically precise examina-
tion of the relationships between study findings and
study features of this kind. Our study examined
whether effects were moderated by the age and gen-
der of children, the different modalities, and the ini-
tial behavior problem scores of the children, but few
significant moderators were found, indicating that
Triple P can be used with success in a diverse range
of families. The results showed that the Triple P
Level 4 interventions improved the parenting styles
and the competences of parents, as self-reported by
the parents. Improvements were sustained over time
and even seem to have increased somewhat in the
long term. The positive effects of Triple P as shown
in this study seem to support the adoption and
implementation of the Triple P Level 4 interven-
tions presently being used in an increasing number
of diverse cultural contexts around the world.
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Family Relations Volume 57, Number 5 December 2008566
... Behavior problems are prominent among children and adolescents (1,2) and parenting programs have shown to be effective in reducing disruptive behaviors (3)(4)(5)(6). However, many parents do not have access to such programs due to several barriers, such as a shortage of human therapists (7). ...
Article
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Background The use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country. Methods A sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed. Results 66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]). Conclusions Overall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.
... Promoting child mental health has been identified as a key public health issue [1][2][3]. Most forms of child mental health treatment involve parents, with many efficacious interventions even focusing exclusively on parents, most commonly in the form of parent skills training [4,5]. Parent-based skill training, or parenting education, can take the form of parenting groups, individual treatment, self-help (such as parenting books), and web-based programs. ...
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Background Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement. Objective We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated. Methods In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria. Results Three PRAM factors emerged (“Acceptability of Parenting Resources,” “Interest in Learning Parenting Strategies,” and “Acceptability of Parenting Websites”), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited. Conclusions The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement.
... The Parenting Scale (PS) was developed to assess dysfunctional parental discipline strategies (Arnold et al., 1993) and is one of the most frequently employed questionnaires in clinical and research practice on parenting (Pritchett et al., 2011). As previous research showed, several studies have utilized the PS to assess dysfunctional parenting as a main outcome of their intervention studies, given its sensitivity to change (De Graaf et al., 2008;Nowak & Heinrichs, 2008). As a 30-item self-report measure, it consists of three subscales: Laxness (highly permissive and inconsistent parenting behavior), Overreactivity (harsh, impulsive, and aggressive parenting), and Verbosity (repeated talking instead of taking action). ...
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This study assessed the psychometric properties of three versions of the Parenting Scale (PS; original PS, 13‐item version, and 10‐item version) in three European middle‐income countries. The PS is one of the most frequently used questionnaires for measuring dysfunctional discipline strategies. Although its validity has been extensively investigated in American samples, there are mixed results regarding the recommended number of items and subscales, raising the question of replicability across European middle‐income countries. Multigroup confirmatory factor analysis (MCFA) and item response theory (IRT) were applied to N = 835 parents from North Macedonia, Moldova, and Romania. All three versions were significantly correlated with parental‐ and child‐related variables. Confirmatory factor analysis indicated the best model fit for the 10‐item version, and configural and partial metric invariance across countries could be established for this version. Item response theory analyses also supported this measure. Our findings show that the 10‐item version performed better than the 13‐item version and the original PS both overall and on the country level. Reliability values were somewhat lower than reported in studies from the United States. The 10‐item version constitutes a promising short measure for assessing dysfunctional parenting in European middle‐income countries for researchers and practitioners.
... Several meta-analyses have been conducted on the effects of Triple P programs. Prior Triple P level 4 meta-analyses evidenced that this level of intervention is particularly effective in decreasing children's behavior problems and in improving parental practices [15][16][17][18]. Nowak and Heinrichs [19] conducted a Triple P meta-analysis to identify moderator variables for program effectiveness and concluded that better results were associated with a more intensive format, particularly for the families revealing higher levels of distress before the intervention. ...
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Supporting parents through the delivery of evidence-based parenting interventions (EBPI) is a way of promoting children’s rights, given the known benefits to child development and family wellbeing. Group Triple P (GTP) is an EBPI suitable for parents of children aged 2–12 years, who experience parenting difficulties, and/or child behavior problems. Even though GTP has been intensively studied, information lacks on the magnitude of its effects, considering the risk of bias within and across prior research. To address this, a systematic review and meta-analysis (PROSPERO registration CRD42019085360) to evaluate the effects of GTP on child and parent outcomes at short- and longer-term was performed. Through a systematic search of a set of databases, 737 research papers were identified, and 11 trials were selected. The risk of bias within and across studies was evaluated. Significant positive effects of GTP were found immediately after the intervention for child behavior problems, dysfunctional parenting practices, parenting sense of competence, psychological adjustment, parental stress levels, conflict, and relationship quality. Six months after the intervention, positive effects were found only for child behavior problems. Data suggest that GTP might be an effective EBPI leading to positive family outcomes. Substantial risk of bias was found, highlighting the importance of improving the quality of research.
... Besides a total score, three subscales can be calculated: overreactivity, laxness, and verbosity. The PS is one of the most commonly used measures for assessing dysfunctional parental discipline in clinical and research settings (Graaf et al., 2008, Pritchett et al., 2011. Its psychometric properties (i.e., validity and reliability) have been investigated in several studies (Salari et al., 2012). ...
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Parental burnout (PB), a relatively new and under-studied construct, is defined as a condition resulting from chronic parenting stress. While recent research confirmed its negative associations with familial variables, such as relationship satisfaction and positive parenting practices, little is known about the role of intimate partner violence (IPV) and how it relates to parental burnout. The present study, therefore, aimed to extend existing knowledge on chronic parenting stress by 1) testing for the mediational role of couple dissatisfaction in explaining the link from IPV victimization to PB as well as the link from IPV victimization to dysfunctional parenting, and 2) investigating how specialist gender roles and parental responsibilities for child care relate to IPV victimization and PB. Data collection was part of an international collaboration on factors related to parental satisfaction and exhaustion across different countries. Self-report data from Austrian mothers ( N = 121) were collected online and analyzed using structural equation modeling. Results indicated that couple dissatisfaction mediates the link from IPV victimization to PB, as well as IPV victimization to dysfunctional parenting. Furthermore, only specialist gender roles were significantly related to IPV, while parental responsibilities for child care did not significantly relate to experiences of violence. Additionally, neither specialist gender roles nor parental responsibilities were significantly associated with PB in the final model. Overall, our findings connect to family models, such as the Family System Theory and Spillover Theory, underscoring the importance of couples’ relationship quality for understanding parental burnout and parenting behaviors in mothers.
... First, we anticipated that parents who experienced more difficulties providing affiliation, structure or autonomy support at pre-intervention (i.e., who scored a standard deviation below average on a given parenting component) would benefit more from the program than those experiencing fewer difficulties at pre-intervention, presumably because they would be less familiar with its skills. Second, based on meta-analytic reviews of other parenting programs using a universal approach, we did not expect child age nor child sex to moderate the program's efficacy (e.g., de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008), but hypothesized that any parent gender difference would result in larger positive changes for mothers than fathers (e.g., Fletcher, Freeman, & Matthey, 2011;Sanders, Kirby, Tellegen, & Day, 2014), arguably because mothers are more likely to be primary caregivers (Galinsky, Aumann, & Bond, 2013;Milan, Keown, & Urquijo, 2011). To describe our Method and Results sections, we follow the CONSORT standard guidelines for social and psychological interventions (Montgomery et al., 2018). ...
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“How to Talk so Kids will Listen & Listen so Kids will Talk” is a universal parenting program hypothesized to teach three key parenting components: autonomy support, affiliation, and structure. To assess its impact on these components, we conducted its first randomized controlled trial. We recruited 293 parent-child dyads, which we randomized into 30 parenting groups. Fifteen groups received the program immediately (How-to condition), while the other half received it 14 months later (waitlist condition). Parents and their child (Mage = 7.60) rated parent autonomy support, affiliation and structure at pre- and post-intervention as well as at six- and twelve-month follow-ups. At post-intervention, parents in the How-to condition reported more autonomy support than parents in the waitlist condition and, for those scoring low on affiliation or structure at pre-intervention, more affiliation and (potentially) structure, respectively. Limited differences were reported by children. Post-intervention differences remained stable over the 12-month follow up.
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Mental illness accounts directly for 14% of the global burden of disease and significantly more indirectly, and recent reports recognise the need to expand and improve mental health delivery on a global basis, especially in low and middle income countries. This text defines an approach to mental healthcare focused on the provision of evidence-based, cost-effective treatments, founded on the principles of sharing the best information about common problems and achieving international equity in coverage, options and outcomes. The coverage spans a diverse range of topics and defines five priority areas for the field. These embrace the domains of global advocacy, systems of development, research progress, capacity building, and monitoring. The book concludes by defining the steps to achieving equality of care globally. This is essential reading for policy makers, administrators, economists and mental health care professionals, and those from the allied professions of sociology, anthropology, international politics and foreign policy.
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Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers’ mental health is one of the most important factors influencing children’s development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the “Integrated Program for Early Childhood Development” on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5–25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent’s age, parent’s education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child’s age, the grandmother’s rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.
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Seven million youngsters--one in four adolescents--have only limited potential for becoming productive adults because they are at high risk for encountering serious problems at home, in school, or in their communities. This is one of the disturbing findings in this unique overview of what is known about young people aged 10 to 17 growing up in the United States today. The book explores four problem areas that are the subject of a great deal of public interest and social concern: delinquency, substance abuse, teen pregnancy, and school failure. In examining these problem areas, Dryfoos has three objectives: to present a more cogent picture of adolescents who are at risk of problem behaviors and where they fit in society; to synthesize the experience of programs that have been successful in changing various aspects of these behaviors; and to propose strategies for using this knowledge base to implement more effective approaches to helping youngsters succeed. Among the key concepts emerging from this study are the importance of intense individual attention, social skills training, exposure to the world of work, and packaging components in broad, community-wide interventions. Schools are recognized as the focal institution in prevention, not only in regard to helping children achieve academically, but in giving young people access to social support and health programs. The author also proposes comprehensive youth development initiatives at the local, state and national level, based on programs shown to be effective in real practice. This landmark, state-of-the-art study represents an indispensable resource for anyone interested in the welfare and current problems of youth, including psychologists, sociologists, school administrators, state and federal officials, policymakers, and concerned parents.
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Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
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Marital Conflict and Child Development. Conflict in the Marital Dyad. Children's Reactions to Marital Conflict. Effects of Specific Aspects of Marital Conflict on Children. Interparental Conflict and the Family. Methodology and Message. Conclusions, Implications, and Guidelines.
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1. Exercise of personal and collective efficacy in changing societies Albert Bandura 2. Life trajectories in changing societies Glen Elder 3. Developmental analysis of control beliefs August Flammer 4. Impact of family processes on self-efficacy Klaus A. Schneewind 5. Cross-cultural perspectives on self-efficacy beliefs Gabriele Oettingen 6. Self-efficacy in educational development Barry Zimmerman 7. Self-efficacy in career choice and development Gail Hackett 8. Self efficacy and health Ralf Schwarzer and Reinhard Fuchs 9. Self-efficacy and alcohol and drug abuse Alan Marlatt, John S. Baer and Lori A. Quigley.
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1.1. Bandura presents the concept of efficacy expectations ambiguously; at times they are discussed as if they include action-outcome expectations, at other times they are contrasted as distinct from these.2.2. It is helpful to keep action-outcome expectations and efficacy expectations conceptually distinct. Failure to do so does not allow consideration of the possibility that psychological treatments for phobias operate by modifying action-outcome expectations, without altering efficacy expectations.3.3. There is no firm experimental evidence to support Bandura's contention that “psychological procedures, whatever their form, serve as means of creating and strengthening expectations of personal efficacy”, or to decide between alternative expectation accounts of the action of psychological treatments.
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Background: Despite a wealth of evidence showing that behavioural family intervention is an effective intervention for parents of children with behavioural and emotional problems, little attention has been given to the relationship between parents functioning at work and their capacity to manage parenting and other home responsibilities. This study evaluated the effects of a group version of the Triple-P Positive Parenting Program (WPTP) designed specifically for delivery in the workplace. Method: Participants were 42 general and academic staff from a major metropolitan university who were reporting difficulties managing home and work responsibilities and behavioural difficulties with their children. Participants were randomly assigned to WPTP, or to a waitlist control (WL) condition. Results: Following intervention, parents in WPTP reported significantly lower levels of disruptive child behaviour, dysfunctional parenting practices, and higher levels of parental self-efficacy in managing both home and work responsibilities, than parents in the WL condition. These short-term improvements were maintained at 4-months follow-up. There were also additional improvements in reported levels of work stress and parental distress at follow-up in the WPTP group compared to post-intervention. Conclusions: Implications for the development of 'family-friendly' work environments and the prevention of child behaviour problems are discussed.