Brief, low-intensity interventions show promise in most comprehensive meta-analysis of the Triple P system to date

The recent publication of The Triple P – Positive Parenting Program: A Systematic Review and Meta-Analysis of a Multi-Level System of Parenting Support in Clinical Psychology Review is the most comprehensive meta-analytical assessment of Triple P to date.

This was the first meta-analysis of the Triple P system to examine the full range of outcomes that Triple P seeks to influence.

The meta-analysis investigated data compiled from reported outcomes of 16,009 families who have participated in a Triple P program over the past 33 years from a range of sources, including independent studies, unpublished studies and agencies delivering Triple P as part of regular service.

The most compelling finding for the value of the Triple P multi-level system is evidence that now shows that all delivery methods of Triple P – as well as the full suite of intervention levels – produce significant effects for children and their families.

This is important given that families themselves differ in terms of their preferences, the amount of time they have available to engage with a parenting program, their location and the presence of other sources of adversity in their lives.

Other findings

The comprehensive nature of the collection of the data and the way it was investigated provides for a range of findings.

Among these, this paper is the first to discover that brief, low intensity parenting interventions such as those provided in Triple P levels one, two and three can have considerable impacts on child and parent outcomes.

The potential for these low-intensity programs to help complex and vulnerable families, or those traditionally supported by more intensive levels of Triple P, such as levels 4 and 5, has important implications for Triple P’s future as a public health measure and needs to be further explored.

The meta-analysis revealed that there’s evidence to support the impact of Triple P in terms of parents’ reports of what has happened as well as from independent, objective observations.

The research also confirms that benefits for both parents and children are significant regardless of whether the study was conducted by the Parenting and Family Support Centre at the University of Queensland, a developer associated with the program, or a researcher independent of that group.

This was the first meta-analysis of Triple P to provide a systematic and thorough evaluation of the risk of bias across the entire evidence base.

Researchers examined the effect of study power (whether the study had 35 participants or over versus less than 35 participants in the smallest group), publication status (whether or not the research has been published) and developer involvement in research.

Results showed a tendency for smaller studies, ie studies with 35 participants or less, to have larger effect sizes. Whether or not a paper had been published was found to have no impact on effect sizes on child and parent outcomes and developer involvement was found to affect on only one of the five main outcomes.

It’s important to note that the data from the 47 studies with 35 participants or more in the smallest group still returned significant effect sizes for all five main outcomes.

The results of the meta-analysis showed that the level of developer involvement was not a sufficient explanation for the lack of findings in a small number of independent studies.

When the vast majority of studies, including independent evaluations, find positive effects, other factors such as poor study fidelity, inadequacy of supervision of practitioners or implementation need to be investigated.

There’s also no magic age which benefits most from Triple P.

Similar outcomes were determined for families of children of 0-12 years programs and families of teenagers, which shows that the action in the field of early intervention, treatment and prevention is not all over by age three, as is commonly argued.

The future

The meta-analysis consolidates a solid research foundation built over more than three decades of evaluation research into the Triple P system and will now support the development of even more efficient and effective ways to reach and support families.

One of the main challenges ahead is the development of a cohesive, cost-efficient method of deploying Triple P’s multiple levels of intervention within a whole-of-population strategy.

With that goal, reported data from this meta-analysis is already being used to develop a planning tool to help administrators, funders, agencies and researchers make more accurate predictions of the impacts, costs and potential cost savings from the Triple P system.

It’s the type of tool which will allow administrators and planners to set their own goals for the benefits they want to bring to their communities and provide a framework for how best they can deliver those benefits using the power of their own workforce.

And it’s work such as this which shows the potential for the future.

For the thousands of people around the world who have dedicated their working lives to improving outcomes for children and their families, that’s an extremely exciting and energising prospect.

Disclosure statement

The Triple P – Positive Parenting Program is owned by the University of Queensland. The University through its main technology transfer company, UniQuest Pty Ltd, has licensed Triple P International Pty Ltd to publish and disseminate the program worldwide. Royalties stemming from published Triple P resources are distributed to the Parenting and Family Support Centre; School of Psychology; Faculty of Health and Behavioural Sciences; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International.