Fifteen-year follow-up study suggests Group Triple P led to long-term improvements in children’s literacy, numeracy and school attendance

shutterstock_373108393A 15-year follow-up of a Group Triple trial in Perth, Western Australia, suggests Triple P contributed to long-term improvements in literacy and numeracy for primary school children and better attendance for high-schoolers.

The Western Australian report, A 15 Year Follow-Up of the WA Triple P Trial, was prepared by Grant Smith at the Collaboration for Applied Research and Evaluation at the Telethon Kids Institute in Perth for the Western Australian Department of Health.

The study looked at 15 years of Western Australian administrative data to determine whether Triple P was associated with long-term benefits.

Performance on the Western Australian Literacy and Numeracy Assessment (WALNA) in Years 3, 5 and 7, as well as the rate of school absence in Year 11 from Department of Education databases, were linked to data from the original Western Australian evaluation of Group Triple P in 1996.

“Whilst the noted effects of the intervention on reading and numeracy achievement were small (between 2.0% and 5.5%), it is remarkable (though not unexpected) to find lasting academic effect of an eight session parenting intervention carried out when the child was between three and five years of age,’’ the report states.

“Given the relatively low time-burden Triple P poses for parents (a total of 10-12 hours) and the time between intervention and testing, these effect sizes are not insubstantial.’’

The study points out that differences between the groups who did and did not receive Triple P created some limitations. For example, geographic differences between the two groups suggest differences in schooling may be partially responsible for the observed effects.

“However, the dose-response pattern provides strong evidence for the intervention being responsible for the observed differences in academic performance,’’ the authors state.

Dose response links Triple P to better academic performance

The report explains that the more sessions parents attended, the more likely it was that children would have higher WALNA numeracy and literacy scores in year 7.

Despite a wealth of short- to medium-term studies showing the value of Group Triple P, there are few long-term studies into the effects of the intervention, apart from a four-year investigation of the universal availability of Group Triple P in a selection of preschools in Germany. This study demonstrated improved parenting behaviour (less dysfunctional parenting practices) four years after the intervention.

The Western Australian report also suggests that preschool children whose parents participated in Group Triple P between 1996 and 1997 were less likely to be involved in hospital emergency department visits than children in the comparison group.

However, despite a clear relationship between the intervention and the rate of emergency department visits, it was not conclusive whether this was due to Triple P or unmeasured differences between the intervention and comparison groups.

Group Triple P

Group Triple P is one of the more intensive forms of the Triple P – Positive Parenting Program and is generally accessed by families who have a child with behavioural problems or parents wanting more intensive support to develop positive parenting skills. It involves a combination of face-to-face group sessions and one-to-one telephone support sessions over eight sessions.

In Western Australia at the time of the original evaluation, the program was delivered by community health nurses, social workers, health promotion officers and psychologists recruited from community and child health services within the relevant health region. Facilitators attended a three-day intensive training program and were required to co-facilitate at least three programs with an experienced facilitator.

All families in the intervention group lived in an area where there were high rates of child abuse notifications and high rates of families receiving Family Crisis Program benefits. Families in the comparison group lived in an area with higher-than-state-average child abuse notifications and Family Crisis Program benefits – although not quite as high as the intervention regions.

The follow-up study also suggests Triple P increased use of of community mental health services. This finding might be explained by the fact that the Triple P curriculum encourages appropriate parental engagement with child development services or that a number of the Triple P-trained facilitators were able to refer to mental health services where they had a concern about a child’s psychological well being.

With the evidence still uncertain, where to next for interventions for new parents?

The first three years of life have long been recognised as fundamental to a child’s future development, and the role of parents in those early years is widely acknowledged as being critical.

For the new parent, there is an abundance of information on parenting babies both in the popular media and from health and social service agencies.

Yet how much of this is evidence-based and how much do we really know about what interventions work for parents of under threes?  Although there are still many gaps in our knowledge about parenting interventions for older children, these are minor compared to those for parents of babies.

Triple P is a widely known evidenced-based parenting intervention, and while there is support for its effectiveness in the toddler and pre-schooler years (for example, Morawska & Sanders, 2006) and into the primary school years, there is still limited evidence for interventions that target parents of babies.

This is not unique to Triple P. Most parenting programs target older children, and the majority of evidence-based, widely disseminated programs such as Triple P and Incredible Years is for older children.

Addressing the gap

To address this significant gap in supporting parents in the early years of parenting we developed Baby Triple P. Baby Triple P was designed as a comprehensive, preventative, group-based approach to support parents at the transition to parenthood, and targets known risks factors common across the transition (i.e., early parenting confidence and behaviour, parental coping, and supporting the couple relationship).

Our efforts to evaluate the efficacy of Baby Triple P are ongoing but to date findings have been mixed and largely not supportive of the efficacy of the program.

Interestingly, a recently published pre-post trial of Incredible Years Parents and Babies found limited evidence of effectiveness (Jones, Erjavec, Viktor, & Hutchings, 2016). Incredible Years, like Triple P, is based on social learning principles and has a strong evidence base, so it is intriguing that this version of the program has also shown few positive outcomes.

Four randomised controlled trials to date for Baby Triple P (Mihelic, Morawska, & Filus, 2016b; Seah & Morawska, 2016; Spry, 2013; Tsivos, Calam, Sanders, & Wittkowski, 2015) have shown two things: parents really like the intervention and yet report no or very limited change in any of the outcomes assessed. Each of these trials had significant limitations. For example, the sample in Spry (2013) was older, more educated, better off financially and better adjusted than the general population, thus causing ceiling effects on all outcome measures at baseline.

Several large-scale studies are currently ongoing in Australia and Scotland with more high-risk and vulnerable families. These studies will provide more definitive evidence pertaining to longer term effects of Baby Triple P.

Parents clearly like Baby Triple P

What we do know currently, however, is that parents clearly like Baby Triple P and find it highly acceptable, including families with premature babies (Ferrari, Whittingham, Boyd, Sanders, & Colditz, 2011), mothers in a psychiatric unit (Butler, Hare, Walker, Wieck, & Wittkowski, 2014), and mothers suffering from postnatal depression (Tsivos, Calam, Sanders, & Wittkowski, 2015).

Many parents and practitioners continue to ask for the program, often noting that there simply are no available parenting programs for them. One randomised trial even had to be discontinued because parents so desperately wanted the information in the program (Popp & Schneider, 2015).

Parents of babies clearly want evidence-based parenting programs. Practitioners tell us that few options are available and are very keen to know when Baby Triple P will become available.

verticle babyHowever, the research evidence for all parenting interventions targeting new parents suggests that all existing approaches to date have had limited effects.

Systematic reviews of specifically targeted interventions have found limited evidence of positive effects for outcomes such as infant sleep for babies under 6 months of age (Douglas & Hill, 2013).

Our own recent meta-analysis of interventions targeting early infant and parenting behaviours (Mihelic, Morawska, & Filus, 2016a), found only five studies that examined parenting competence and confidence. This means that while parenting skill and their confidence in their own ability as parents are recognised as important (Mihelic, Filus, & Morawska, 2016), few interventions actually aim to help parents enhance these.

A meta-analysis of more than 140 early parenting interventions, starting during pregnancy or the first six-months postpartum, found very small to small intervention effects and only for some outcomes (Pinquart & Teubert, 2010). The authors found that shorter, more targeted interventions, and older studies tended to show stronger effects.

The fact that older studies tend to show larger effect sizes might suggest that parents these days have access to much more information at their fingertips, making it more difficult for modern-day studies to show effects. However, we are still a long way from knowing whether or not this is the case. What we do know that despite this abundance of information, parents still clearly want an intervention such as Baby Triple P.

So where to now for Baby Triple P, a program that has been much anticipated by many people familiar with the Triple P system of programs?

We think the theoretical approach we have taken is sound, and the specific strategies incorporated into Baby Triple P are appropriate, but we have begun rethinking how we design the intervention and how we target delivery to parents with specific needs.

Perhaps we have tried to target too many varied factors within the existing intervention, making the job of detecting the effects on a specific outcome, such as baby crying, too difficult? Our next efforts will involve more targeted interventions, focusing on parents with identified needs.

At the same time, we will continue to work with parents and examine the theoretical literature to determine how best to tailor the program.

Parenting in infancy matters and we need to make sure we design and test effective programs for parents. And although it can be tempting to disseminate a program that parents and practitioners are asking for, Baby Triple P has not yet been disseminated.

We will continue to develop and test interventions for parents of babies in an effort to support those fundamental early days and months of development.


Other references:


Mihelic, M., Morawska, A., & Filus, A. (2016a). Effects of early parenting interventions on parents and infants: A meta-analytic review. Under review.

Mihelic, M., Morawska, A., & Filus, A. (2016b, 22-25 June). How effective is Baby Triple P for parenting confidence and the mother-infant relationship? . Paper presented at the 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, Australia.

Seah, C. K. F., & Morawska, A. (2016). Does Baby Triple P increase responsive parenting, efficacy and reduce parental stress? A randomized controlled trial of an early parenting intervention. Under review.


Triple P goes to the White House

Representatives from Triple P America, the organisation licensed to disseminate Triple P in the United States, will attend the event at the invitation of the White House Office of Social Innovation and My Brother’s Keeper (MBK).

UQ Vice-Chancellor and President Professor Peter Høj said Triple P’s invitation to the White House showed a welcome belief that the pursuit of quality research could help overcome persistent global problems, such as a lack of opportunity for young men and boys of colour.

“The continued development and evaluation of Triple P internationally is an outstanding example of how research conducted in direct response to social need can inform the development of programs designed to improve the lives of individuals and  families while also providing community-wide benefits,’’ Professor Høj said.

Triple P founder and UQ Parenting and Family Support Centre director Professor Matt Sanders said the invitation to present at the White House was a strong endorsement for the program.

“The My Brother’s Keeper What Works presentation at the White House aims to give communities and the philanthropic and corporate sectors guidance on the type of quality, evidence-based programs they can be considering as part of this wonderful initiative,’’ Professor Sanders said.

“Internationally, and particularly in the US, we have seen that Triple P used in partnership with other evidence-based programs means great things can happen to provide opportunities for children and youth.’’

My Brother’s Keeper was established two years ago by US President Barack Obama to ensure all young people in the US reached their full potential.

Nearly 250 communities spanning all 50 US states have accessed $1.6 billion in private sector and philanthropic grants and low-interest financing as part of the initiative.

Triple P America Chief Executive Officer Bradley Thomas said Triple P had been invited to participate because its programs had been identified as being able to support the first of six My Brother’s Keeper milestone areas which encourage positive outcomes across the lifespan.

This milestone was ‘Getting a healthy start and entering school ready to learn’.

“Triple P America’s invitation to the White House is an indication of the strong evidence base of the Triple P system, as well as the outstanding results being obtained by sites rolling out the program in the United States,’’ Mr Thomas said.

The event can be viewed at

Home-visiting program plus Triple P shows significant improvements for children’s early cognitive development

Cute Toddler Child - 3

One of the most extensively conducted randomised controlled trials of an early childhood intervention program in Europe has shown that a home visiting program combined with the Triple P – Positive Parenting Program improved children’s cognitive development.

Results of a University College Dublin evaluation of the Preparing for life program include a finding that children in the high treatment group whose families participated in the full intervention had a 10-point IQ gap over children in the low treatment group.

Previous evidence of positive impacts of home visiting programs on children’s cognitive development before starting school has been limited.

As the study’s evaluation report states:

Only a small number of studies have found favourable intervention effects during the early years . .  However, the results are mixed and there is much variation in the effect sizes found by different programmes (Filene et al., 2013).

Preparing for Life (PFL) is a community-led initiative operated by the Northside Partnership in North Dublin and was evaluated over a seven-year period by the UCD Geary Institute under the direction of Dr Orla Doyle, an economist who has been awarded the Barrington Medal for her work in the economic and social sciences.

More than 200 families in designated disadvantaged areas of Dublin were involved in the trial, with the program aiming to help parents develop skills to help their children in five domains of school readiness:

  • cognitive development
  • physical health and motor skills
  • social, emotional & behavioural development
  • approaches to learning
  • language development and literacy

Parenting and Family Support Centre director and Professor of Clinical Psychology, Professor Matt Sanders, said PFL home-visiting mentors were trained to offer parents information about parenting and child development over a period of five years. They were also trained to deliver Triple P.

“Consequently, the principles and techniques of Triple P influenced the way in which mentors encouraged parents to interact with their children,” Professor Sanders said.

Access to a baby massage program was also available as well as access to additional Triple P programmes, such as Group Triple P.

The home visits started with mothers during pregnancy at 21 weeks and continued until the child started school at age four or five.

As part of the trial, a high treatment group received the full intervention, compared to a low-treatment group which did not receive the mentoring program, additional Triple P access or the baby massage program.

According to the final evaluation report, by school entry, the PFL program had a significant and large impact on children’s cognitive development. Children who received the high treatment supports had better general cognitive functioning, spatial abilities, non-verbal reasoning skills, and basic numeracy skills. This means that they were better at understanding information, seeing patterns, solving problems, and working with numbers.



Major impacts when the children were at school entry age included:

  • children in the high treatment group had a 10 point IQ gap over children in the low treatment group
  • 25 per cent of high treatment children had above-average verbal ability, compared to eight  per cent of low treatment children
  • High treatment children were better able to control their attention
  • 25 per cent of high treatment children were not on track in their social competence compared to 43 per cent of low treatment children
  • High treatment children had better gross and fine motor skills

More specifically, the program was shown to have a significant and large impact on:

  • Children’s overall verbal ability
  • Expressive and receptive language skills
  • Communication and emerging literacy skills


PFL had some impact on how children approached learning. Children who received the high treatment supports were better able to manage their attention.

PFL had a significant impact on:

  • Reducing children’s hyperactivity
  • Reducing inattentive behaviours
  • Improving social competencies and autonomy



The program had a significant impact on reducing the amount of hospital services the children used and improved how families used these services. And children in the high treatment group were less likely to:

  • Visit the hospital for urgent reasons
  • Experience fractures
  • Visit the orthopaedics, physiotherapy, paediatrics, ocular and plastic surgery outpatient departments




PFL also had a significant impact on

  • Children’s gross motor skills
  • Children’s fine motor skills
  • Physical independence

(Graphics used in this blog post have been sourced with permission from the final evaluation of Preparing for life by University of College Dublin’s Geary Institute.)

When fathers are more actively involved in parenting, both parents are happier with their relationship: How parenting interventions improve couple relationships

Research into the mechanisms of change between parenting interventions and couple relationship quality suggests that improvements in parenting skills and child behaviour lead to better relationships between parents.

The study, by University of Zurich researchers published in the Journal of Family Psychology, also found that when fathers feel more confident and engaged in parenting, both partners were likely to feel their relationship had improved.

With family breakdown regarded as one of the most central causes of poverty, the research adds to growing evidence that parenting programs have much to offer across a number of policy settings aimed at reducing income inequality and its effects.

Led by Martina Zemp at the School of Psychology at The University of Zurich, the study used data from research published in 2008 to test whether improvements in children’s behaviour after their parents participated in a parenting program could predict better relationship quality for their parents above and beyond the development of better parenting skills.

In the original study, led by Guy Bodenmann from the Institute for Family Research and Counseling at The University of Fribourg, 50 couples were randomly assigned to participate either in Couples Coping Enhancement Training (CCET), Group Triple P or a control group. The research was conducted in Zurich with families of children aged from 2 – 12 years. Researchers followed up with the families a year later.

The original 2008 study found that mothers in the Triple P group showed significant improvements in parenting, parenting self-esteem and a decrease in stressors related to parenting. They also reported significantly lower rates of child misbehaviour than the other two conditions. However, only a few significant results were found for fathers and overall, positive effects of relationship training were somewhat lower than those for Triple P.

In the 2016 study, the authors re-analysed the original data to investigate whether improvements in children’s behaviour were related to better couple relationships for parents.

Links between improved child behaviour and better relationships

The researchers found that mothers who reported improved child problem behaviour a year after participating in Triple P also reported improved couple relationship quality.

“Among fathers, however, it was not their evaluations of improved child problem behaviour, but rather their self-reported improvement of parenting skills which significantly predicted both fathers’ and mothers’ relationship quality at the 1-year follow-up,’’ the authors write.

“None of these effects were apparent in the control group, indicating that the reported findings may not be considered natural processes but likely occurred as a result of parents’ participation in Triple P.’’

So the role of parenting appears to have important implications for the quality of couple relationships, with both parents reporting better relationships when fathers are more actively engaged in child rearing.

In the discussion, lead author Martina Zemp and colleagues explore the idea that fathers may be less sensitive to child problem behaviours than mothers because they spend comparatively less time with their children.

“Studies have generally found that fathers report fewer problem behaviours in children than mothers (Bornstein, 2014),’’ they write. “This circumstance may also contribute to our finding that improvement in child problems did not directly affect fathers’ relationship quality.’’

Parents working together as a team

However, a New Zealand randomised controlled trial which set out to enhance father engagement in Group Triple found that both mothers and fathers reported improvements in disruptive behaviour in their children following the intervention.

Writing in Behaviour Therapy, Tenille Frank and colleagues explain that they decided to involve both parents in the design of the study because of previous findings that improvements in child behaviour are more likely to be maintained over time when both parents take part in a program.

“One reason for these findings is that as both parents get the same message about child behavior management strategies they may be able to support and help each other, leading to greater interparental consistency and lower conflict (Bagner & Eyberg, 2003; Webster-Stratton, 1985),’’ the authors explain.

“Parenting strategies are more likely to be effective when both parents agree on one approach (Arnold, O’Leary, & Edwards, 1997) and implement it consistently (Frick, Christian, & Wootton, 1999.’’

“Children’s positive adjustment has been associated with high-quality co-parenting behaviors, such as teamwork and support for the other parent, lack of conflict over child-rearing, and agreement on child-related topics (Teubert & Pinquart, 2010).’’

So, while children benefit from parents working together as a team, as Frank et al. discovered in the New Zealand trial, it is also evident that “parents who are able to work constructively together as a team on parenting issues are also more satisfied in their close relationship’’ as the Zurich authors write.

As Zemp et al. note in their conclusion: “First they (our findings) suggest that children’s problem behavior may affect the parents’ relationship quality over time. Second, the findings also highlight the possibility that prevention programs that are designed to reduce child problem behaviour may have added value in strengthening the couple’s relationship quality.’’


How babies and a narrative of recovery might help mothers who experience postpartum psychosis

The role of the baby as both the cause and agent of recovery for women suffering from postpartum psychosis is part of the clinical and research work of Triple P Research Network member Dr Anja Wittkowski.

Two qualitative studies at the centre of this work were presented at the World Congress of Behavioural and Cognitive Therapies in Melbourne last month.

Dr Wittkowski’s research focuses on a time when most women anticipating the arrival of their baby are hoping to feel wonderful. But some may find themselves frightened, confused and, more than likely, sectioned under their country’s relevant Mental Health Act.

Dr Anja Wittkowski

Dr Anja Wittkowski

Rare but rapid onset

“Postpartum psychosis is quite rare, with around one in 1000 mothers giving birth experiencing it,’’ Dr Wittkowski said during a recent visit to UQ’s Parenting and Family Support Centre, following the World Congress. “It usually comes on very quickly within a few days of giving birth and it almost always requires an inpatient admission.

“It is an incredibly significant life event which can make the women who experience it question their very identity. But my impression is that many of these women go on to live normal, fulfilling lives as both women and mothers.’’

Dr Wittkowski said any pregnant woman could be at risk of developing the condition but an underlying bipolar disorder, or a previous postpartum psychosis, appears to increase the risk of experiencing it.

Dr Wittkowski is a senior lecturer in clinical psychology at The University of Manchester, the current Research Director for the Clinical Psychology Doctorate program at The University of Manchester as well as a clinical psychologist at the 10-bed Mother and Baby Unit (MBU) on Andersen Ward at Wythenshawe Hospital operated by the Manchester Mental Health and Social Care Trust.

Mothers who are admitted to Andersen Ward may be experiencing problems such as postnatal depression, postpartum psychosis or an exacerbation of an existing mental health problem, such as psychosis or bipolar affective disorder.

Dr Wittkowski’s first study involved conducting qualitative interviews with 12 women and was aimed at developing a theoretical understanding of recovery from psychosis following childbirth. This study was published in the journal BMC Psychiatry.

“We know from our first study that the first step in recovering from a postpartum psychosis is gaining an initial understanding of what you have experienced,’’ Dr Wittkowski said. “We know someone has a sense of realisation when they ask their friends or family, ‘what did I say, what did I do’, and can’t believe they did what their friends and family are telling them they did.

“Once they realise that they had very unusual (often psychotic) experiences, these women experience a great sense of loss. They had been anticipating that after giving birth they were going to experience the best feeling in the world but the next minute they are frightened and confused.

Losing a piece of themselves

“This period of experiencing acute psychotic symptoms is not viewed by these women as representative of what they are normally like. As part of recovery, they have told us that they had to accept that they have lost a little bit of themselves, such as their sense of security, their knowledge of being a stable persoverticle babyn or just time. But the women we interviewed told us that they used those experiences positively.

“In my clinical experience I can begin to see women recover when they start to develop a narrative about their experiences, partly as a way of explaining to others what happened to them – and why they had to b
e admitted to a psychiatric unit – but mostly so they have a way of explaining those very unusual experiences to themselves.’’

One of the women I worked with expressed this process of acceptance really nicely. She told me that she really liked musical animation. She explained that during her acute illness phase she was found hiding away in her room but singing these songs. She later said to me that singing these songs ‘helped me through the darkest moments in my life’.”

Because of the importance of psychosocial factors in the role of recovery, Dr Wittkowski said the research team asked the women in their first study about the things that had helped their recovery and the women identified that their relationships with family members and mental health staff had been very helpful.

“When these women talked about their relationships with others, one very strong theme emerged: none of these women mentioned their baby,’’ Dr Wittkowski said. “We were thinking about how odd that was and that informed the design of the second study. As the baby is a reason why women become extremely unwell in the first place, we wanted to know about the role of the baby in their recovery from postpartum psychosis.

Mothers who took part in the second qualitative study told us that the baby is central to their recovery and the baby was perceived a facilitator but the baby was also a barrier to recovery. These findings reflected what we had seen in clinical practice on the unit.

“The mothers also told us they felt they had to sacrifice their own wellbeing for the sake of the baby.’’

The second as yet unpublished study underlined the value of the work of the Mother and Baby Unit which centres around mothers’ wellbeing but also encouraging mothers to look after their babies and bond with them.

“We know that by looking after the baby, these women achieve a greater sense of self-confidence which helps their recovery,’’ she said.

Baby Triple P

Dr Wittkowski and fellow researchers are about to embark on a new study in which the Baby Triple P program will be offered at the Mother and Baby Units in Birmingham and Manchester. Funded by a National Institute of Health Research for Patient Benefit grant in the UK, they will be working with women who have been admitted for a range of mental health difficulties, including psychosis, postnatal depression, having thoughts of harming their child, stress, bonding problems, or existing problems, such as OCD, anxiety and/or depression.

“Baby Triple P just fits in so well with what we are doing,’’ Dr Wittkowski said. “When I first came across Baby Triple P I liked the fact that it had two sessions on dealing with the relationship between mother (or parent) and baby, two sessions for coping and building social support and four sessions for skill implementation via phone support.

“It’s really nice that there are four weeks of phone support so we get to see how the women manage the transition from having been on the unit to being back at home.”

“When we ran our mini-pilot, one of the women told me she really liked the idea of knowing that she could ring me after having been discharged from the Mother and Baby Unit.

“The study is a feasibility study looking at the possibility of recruiting women in this setting, whether they would be ok with being randomly allocated to treatment as usual plus the intervention or treatment as usual only and whether we can retain them throughout the study.’’







First randomised trial of a parenting program in mainland China shows Group Triple P has a positive impact on children’s academic lives

shutterstock_276608939A paper published in the journal Behavior Modification explores whether the development of more westernised parenting practices in China over the past four decades would mean that western-developed parenting programs would be effective with Chinese families.

The randomised controlled trial of Group Triple P, the first RCT of a western-developed parenting program in mainland China, found that Group Triple P significantly improved dysfunctional parenting and parental adjustment, increased parents’ confidence and reduced child adjustment problems.

The introduction of Triple P to Shanghai parents of children from grades one to three who were worried about their child’s schooling also sought to find out if Triple P could have a positive impact on children’s academic lives.

The findings suggest that may be the case, with participation in Group Triple P leading to parents becoming more satisfied with their child’s academic performance and the children showing less problem behaviours related to learning, according to the parents.

All effects were maintained six months after the parents participated in the program.

Academic performance

Former PhD student of the Parenting and Family Support Centre at The University of Queensland, Dr Mingchun Guo, said that improved parental satisfaction in academic performance may have been brought about because parents had adjusted their expectations of their children and had become more accepting of their academic achievement. Alternatively, there may have been an actual change in the child’s academic achievement.

“Unfortunately, we were not able to measure academic performance directly in this study, although a recent 15-year follow-up study in Western Australia indicated Group Triple P , when delivered to parents of children aged at 3 to 4 years, produced sustained improvements in children’s literacy and numeracy scores once at school.’’

The Chinese study was also a rare attempt to investigate parenting changes from the child’s perspective, with children reporting that their parents used significantly more positive parenting practices after participating in Group Triple P. However, Dr Guo cautioned that more research was needed to explore children’s views on changes in parenting practices.

The study found no change on children’s reports of corporal punishment in the home either at post-intervention or six-month follow-up, however, Dr Guo suggests this may have been caused by a floor effect due to the low average level of corporal punishment reported by parents in the study.

“Triple P encourages nurturing, engaging, consistent, and assertive parenting; hence, it coaches authoritative parenting,’’ Dr Guo writes. “As recent research has shown that Mainland Chinese parents endorse authoritative parenting and this is positively related to children’s social and school adjustment, it is not surprising that Group Triple P had positive effects on a range of parent and child outcomes in this study.’’

In introducing the study, Dr Guo places parenting in the context of the drastic changes in economy, education, family structure and family lives that China has experienced in the past four decades.

Confucian philosophy and filial piety

He said Confucian philosophy and values such as filial piety, or respect for one’s parents, had played a major role in Chinese parenting practices with Chinese parents typically depicted as emphasising the need for parental authority and obedience from children.

But such attitudes may have relaxed to some extent with suggestions that the one-child policy, for example, had led to Mainland Chinese parents becoming more indulgent with their children.

A recent empirical study also found that Mainland Chinese parents predominantly endorsed authoritative rather than authoritarian parenting, they emphasized egalitarian and the two-way parent-child relationship and were warmth-oriented rather than control-oriented toward their children.

Dr Guo writes that these findings on parenting styles were substantially different than those found in studies conducted one and two decades previously, suggesting Chinese parenting practices had become more similar to Western-style parenting.

In this context, it was likely that Mainland Chinese parents, particularly those in urban areas, would accept and use parenting strategies from a Western-developed program. This particular trial suggests that this may well be the case.

Delivering a population rollout of the Triple P – Positive Parenting Program takes planning and commitment. But help is available. And the rewards are strong outcomes and sustained delivery

The team behind the successful rollout of the Triple P – Positive Parenting Program in the Irish Midlands has put its experiences into an implementation guide for other organisations wanting to improve the quality of life for children and parents at a population level.

The guide, Getting Started – Getting Better, sets out to help agencies considering implementing Triple P’s population health approach.

The Triple P multi-level system of parenting programs was delivered community-wide in the Irish Midlands by the Midlands Area Parenting Partnership (MAPP), which included representatives from the Irish Health Services Executive as well as community organisations. You can read about the evaluation of the project, funded by Atlantic Philanthropies, here.

That 2014 evaluation determined that a number of health outcomes for children and parents changed at the population level, including a 37.5 per cent drop in the numbers of children experiencing clinically elevated levels of social, emotional and behavioural problems.

When organisations such as MAPP and others around the world get it right, everyone wants to know the secret. With that in mind, the team behind MAPP have collected their experiences into a guide suitable for organisations with similar levels of capacity. It sets out to help organisations navigate what can often be the tricky process of embedding a system of evidence-based programs into a sustained delivery model that is implemented with fidelity.

Triple P founder and director of the Parenting and Family Support Centre at The University of Queensland, Professor Matt Sanders, described MAPP as a group which had valued the Triple P population approach from the start. MAPP had developed their own organisational structures to ensure the Triple P system was implemented with fidelity and quality assurance mechanisms were built in.

“MAPP understood from the outset the importance of building in local evaluations of evidence-based programs to ensure quality delivery. They learnt how to adapt to change and continue working on the sustained delivery of the program,’’ Professor Sanders said.

Best-practice example of organisational self-regulation

Professor Sanders described MAPP’s delivery of the Triple P system as a best-practice example of organisational self-regulation at work, to the extent that MAPP had designed their own system of implementation and evaluation to ensure the outcomes they were seeking for children and families were achieved.

“The principal of self-regulation and minimal sufficiency lies at the heart of the behaviour change model inherent in the Triple P – Positive Parenting Program and it’s always great to see this tenet at work with parents and children and practitioners. This is a great example of self-regulation and minimal sufficiency at work at an organisational level,’’ Professor Sanders said.

Around the same time as the MAPP rollout, The University of Queensland’s commercial partner in the worldwide delivery of Triple P, Triple P International (TPI), began to develop an Implementation Framework to create a way for TPI to support organisations in the delivery of Triple P, depending on the needs of the delivery organisation.

The story of how the TPI Implementation Framework was developed, the research and program delivery experience it was built on, and how it works to support organisations delivering Triple P has just been published in high-impact journal Prevention Science.

The Triple P Implementation Framework: The Role of Purveyors in the Implementation and Sustainability of Evidence-based Programs explains that while organisations are encouraged and supported to become independent problem solvers to overcome implementation obstacles (self-regulation), they are also supported from the outset by TPI Implementation Consultants. These consultants provide a level of support adjustable to the often differing levels of need of delivery organisations (minimal sufficiency).

Author of the Prevention Science article, Jenna McWilliam, described MAPP as a best-practice example of an organisation which had required a relatively minimal level of implementation support from TPI.

“The development of the Implementation Framework was prompted by feedback from organisations faced with challenges implementing Triple P, such as understanding the particular needs of implementing Triple P in the adoption phase and how to effectively sustain implementation,’’ Ms McWilliam said.

“It’s always extremely encouraging to see organisations understanding the model behind Triple P and applying it in various ways around the world,’’ Professor Sanders said. “They are taking the evidence and making it their own. We can only encourage and applaud such organisations while endeavouring to do everything we can to support others to implement the Triple P system.’’