Triple P-Positive Parenting Program: Towards an Empirically Validated Multilevel Parenting and Family Support Strategy for the Prevention of Behavior and Emotional Problems in Children

  • Matthew R. Sanders
Article

Abstract

This paper outlines the theoretical and empirical foundations of a unique multilevel parenting and family support strategy designed to reduce the prevalence of behavioral and emotional problems in preadolescent children. The program known as Triple P-Positive Parenting Program is a multilevel system of family intervention, which provides five levels of intervention of increasing strength. These interventions include a universal population-level media information campaign targeting all parents, two levels of brief primary care consultations targeting mild behavior problems, and two more intensive parent training and family intervention programs for children at risk for more severe behavioral problems. The program aims to determine the minimally sufficient intervention a parent requires in order to deflect a child away from a trajectory towards more serious problems. The self-regulation of parental skill is a central construct in the program. The program uses flexible delivery modalities (including individual face-to-face, group, telephone assisted, and self-directed programs) to tailor the strength of the intervention to the requirements of individual families. Its multidisciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatized access points through primary care services for families who are reluctant to participate in parenting skills programs. The available empirical evidence supporting the efficacy of the program is discussed and its implications for research on dissemination are discussed.

Prevention parenting family intervention dissemination 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Azar, S. T., & Rohrbeck, C. A. (1986). Child abuse and unrealistic expectations: Further validation of the Parent Opinion Questionnaire. Journal of Consulting and Clinical Psychology, 54, 867-868.Google Scholar
  2. Backer, T. E., Liberman, R. P., & Kuehnel, T. G. (1986). Dissemination and adoption of innovative psychosocial interventions. Journal of Consulting and Clinical Psychology, 54, 111-118.Google Scholar
  3. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.Google Scholar
  4. Bandura, A. (1995). Self-efficacy in changing societies. New York: Cambridge University Press.Google Scholar
  5. Barkley, R. A., Guevremont, D. C., Anastopoulos, A. D., & Fletcher, K. E. (1992). A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 60, 450-462.Google Scholar
  6. Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1997). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 65, 627-635.Google Scholar
  7. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.Google Scholar
  8. Biglan, A. (1992). Family practices and the larger social context. New Zealand Journal of Psychology, 21(1), 37-43.Google Scholar
  9. Biglan, A. (1995). Translating what we know about the context of antisocial behavior into a lower prevalence of such behavior. Journal of Applied Behavior Analysis, 28, 479-492.Google Scholar
  10. Chamberlain, P., & Patterson, G. R. (1995). Discipline and child compliance in parenting. In M. H. Bornstein (Ed.), Handbook of parenting, Vol. 4: Applied and practical parenting (pp. 205-225). Mahwah, NJ: Erlbaum.Google Scholar
  11. Christensen, A. P., & Sanders, M. R. (1987). Habit reversal and DRO in the treatment of thumbsucking: An analysis of generalization and side effects. Journal of Child Psychology and Psychiatry, 28, 281-295.Google Scholar
  12. Christopherson, E. R. (1982). Incorporating behavioral pediatrics into primary care. Pediatric Clinics of North America, 29, 261-295.Google Scholar
  13. Coie, J. D. (1996). Prevention of violence and antisocial behavior. In R. D. Peters & R. J. McMahon (Eds.), Preventing childhood disorders, substance abuse, and delinquency (pp. 1-18). Thousand Oaks, CA: Sage.Google Scholar
  14. Connell, S., Sanders, M. R., & Markie-Dadds, C. (1997). Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas. Behavior Modification, 21, 379-408.Google Scholar
  15. Cummings, E. M., & Davies, P. (1994). Children and marital conflict: The impact of family dispute and resolution. New York: Guilford.Google Scholar
  16. Cunningham, C. E. (1996). Improving availability, utilization, and cost efficacy of parent training programs for children with disruptive behavior disorders. In R. D. Peters & R. J. McMahon (Eds.), Preventing childhood disorders, substance abuse, and delinquency (pp. 144-160). Thousand Oaks, CA: Sage.Google Scholar
  17. Dadds, M. R., Sanders, M. R., & Bor, W. (1984). Training children to eat independently: Evaluation of mealtime management training for parents. Behavioural Psychotherapy, 12, 356-366.Google Scholar
  18. Dadds, M. R., Schwartz, S., & Sanders, M. R. (1987). Marital discord and treatment outcome in the treatment of childhood conduct disorders. Journal of Consulting & Clinical Psychology, 55, 396-403.Google Scholar
  19. Dishion, T. J., & McMahon, R. J. (1998). Parental monitoring and the prevention of child and adolescent problem behavior: A conceptual and empirical formulation. Clinical Child and Family Psychology Review, 1, 61-75.Google Scholar
  20. Dryfoos, J. G. (1990). Adolescents at risk: Prevalence and prevention. New York: Oxford University Press.Google Scholar
  21. Emery, R. E. (1982). Interparental conflict and the children of discord and divorce. Psychological Bulletin, 92, 310-330.Google Scholar
  22. Fixsen, D. L., & Blase, K. A. (1993). Creating new realities: Program development and dissemination. Journal of Applied Behavior Analysis, 26, 597-615.Google Scholar
  23. Forehand, R. L., & Long, N. (1988). Outpatient treatment of the acting out child: Procedures, long term follow-up data, and clinical problems. Advances in Behavior Research and Therapy, 10, 129-177.Google Scholar
  24. Forehand, R., Miller, K. S., Dutra, R., & Watts Chance, M. W. (1997). Role of parenting in adolescent deviant behavior: Replication across and within two ethnic groups. Journal of Consulting and Clinical Psychology, 65, 1036-1041.Google Scholar
  25. Grych, J. H., & Fincham, F. D. (1990). Marital conflict and children's adjustment: A cognitive-contextual framework. Psychological Bulletin, 108, 267-290.Google Scholar
  26. Hart, B., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis, 8, 411-420.Google Scholar
  27. Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Baltimore: Paul H. Brookes.Google Scholar
  28. Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52.Google Scholar
  29. Kazdin, A. E. (1987). Treatment of antisocial behaviour in children: Current status and future directions. Psychological Bulletin, 102, 187-203.Google Scholar
  30. Lawton, J. M., & Sanders, M. R. (1994). Designing effective behavioral family interventions for stepfamilies. Clinical Psychology Review, 14, 463-496.Google Scholar
  31. Lochman, J. E. (1990). Modification of childhood aggression. In M. Hersen, R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior modification (Vol. 25, pp. 47-85). New York: Academic Press.Google Scholar
  32. Loeber, R., & Farrington, D. P. (1998). Never too early, never too late: Risk factors and successful interventions for serious and violent juvenile offenders. Studies on Crime and Crime Prevention, 7(1), 7-30.Google Scholar
  33. Markie-Dadds, C., & Sanders, M. R. (1999). Self-directed Triple P-Positive Parenting Program for parents of children at high and low risk of developing conduct problems. Manuscript submitted for publication.Google Scholar
  34. Markie-Dadds, C., Sanders, M. R., & Smith, J. I. (1997). Self-directed behavioural family intervention for parents of oppositional children in rural and remote areas. Paper presented at the 20th National Conference of the Australian Association for cognitive and Behavior Therapy, Brisbane, Queensland, Australia.Google Scholar
  35. Markie-Dadds, C., Sanders, M. R., & Turner, K. M. T. (1999). Every parent's self-help workbook. Brisbane, Australia: Families International Publishing.Google Scholar
  36. Markie-Dadds, C., Turner, K. M. T., & Sanders, M. R. (1998). Triple P tip sheet series for infants. Brisbane, Australia: Families International Publishing.Google Scholar
  37. McMahon, R. J. (in press). Parent training. In S. W. Russ & T. Ollendick (Eds.), Handbook of psychotherapies with children and families. New York: Plenum Press.Google Scholar
  38. McNeil, C. B., Eyberg, S., Eisenstadt, T. H., Newcomb, K., & Funderbunk, B. (1991). Parent child interaction therapy with behaviour problem children: Generalization of treatment effects to the school setting. Journal of Clinical Child Psychology, 20, 140-151.Google Scholar
  39. Meichenbaum, D. (1974). Self-instructional strategy training: A cognitive prothesis for the aged. Human Development, 17, 273-280.Google Scholar
  40. Mrazek, P., & Haggerty, R. J. (1994). Reducing the risks for mental disorders. Washington, DC: National Academy Press.Google Scholar
  41. National Institute of Mental Health. (1998). Priorities for prevention research at NIMH: A report by the national advisory mental health council workgroup on mental disorders prevention research (NIH Publication No. 98-4321). Washington, DC: U. S. Government Printing Office.Google Scholar
  42. Neilson, A. C. (1997). People Meter Rating Analysis. Sydney, Australia: Author.Google Scholar
  43. Nicholson, J. M., & Sanders, M. R. (1999). Behavioural family intervention with children living in step families. Manuscript submitted for publication.Google Scholar
  44. Patterson, G. R. (1982). Coersive family process. Eugene, OR: Castalia.Google Scholar
  45. Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys. Eugene, OR: Castalia.Google Scholar
  46. Peterson, L., & Saldana, L. (1996). Accelerating children's risk for injury: Mothers' decisions regarding common safety rules. Journal of Behavioral Medicine, 19, 317-331.Google Scholar
  47. Risley, T. R., Clark, H. B., & Cataldo, M. F. (1976). Behavioral technology for the normal middle class family. In E. J. Mash, L. A. Hamerlynck, & L. C. Handy (Eds.), Behavior modification and families (pp. 34-60). New York: Brunner/Mazel.Google Scholar
  48. Robins, L. N. (1991). Conduct disorder. Journal of Child Psychology and Psychiatry, 32, 193-212.Google Scholar
  49. Rutter, M. (1985). Family and school influences on behavioral development. Journal of Child Psychology and Psychiatry, 26, 349-368.Google Scholar
  50. Sanders, M. R. (1992a). Enhancing the impact of behavioural family intervention with children: Emerging perspectives. Behaviour Change, 9(3), 115-119.Google Scholar
  51. Sanders, M. R. (1992b). Every parent: A positive approach to children's behaviour. Sydney, Australia: Addison Wesley.Google Scholar
  52. Sanders, M. R. (1996). New directions in behavioral family intervention with children. In T. H. Ollendick, & R. J. Prinz, (Eds.), Advances in clinical child psychology, Vol. 18 (pp. 283-330). New York: Plenum Press.Google Scholar
  53. Sanders, M. R. (1998). The empirical status of psychological interventions with families of children and adolescents. In L. L'Abate (Ed.), Family psychopathology: The relational roots of dysfunctional behavior. New York: Guilford.Google Scholar
  54. Sanders, M. R., Bor, B., & Dadds, M. R. (1984). Modifying bedtime disruptions in children using stimulus control and contingency management procedures. Behavioural Psychotherapy, 12, 130-141.Google Scholar
  55. Sanders, M. R., & Christensen, A. P. (1985). A comparison of the effects of child management and planned activities training across five parenting environments. Journal of Abnormal Child Psychology, 13, 101-117.Google Scholar
  56. Sanders, M. R., & Dadds, M. R. (1982). The effects of planned activities and child management training: An analysis of setting generality. Behaviour Therapy, 13, 1-11.Google Scholar
  57. Sanders, M. R., & Dadds, M. R. (1993). Behavioral family intervention. Boston: Allyn and Bacon.Google Scholar
  58. Sanders, M. R., & Duncan, S. B. (1995). Empowering families: Policy, training, and research issues in promoting family mental health in Australia. Behaviour Change, 12, 109-121.Google Scholar
  59. Sanders, M. R., & Glynn, E. L. (1981). Training parents in behavioural self-management: An analysis of generalization and maintenance effects. Journal of Applied Behaviour Analysis, 14, 223-237.Google Scholar
  60. Sanders, M. R., Lynch, M., & Markie-Dadds, C. (1994). Everyparent's workbook: A positive guide to positive parenting. Brisbane, Australia: Australian Academic Press.Google Scholar
  61. Sanders, M. R., Markie-Dadds, C., & Turner, K. M. T. (1999). Practitioner's manual for Enhanced Triple P. Brisbane, Australia: Families International Publishing.Google Scholar
  62. Sanders, M. R., & Markie Dadds, C. (1996). Triple P: A multilevel family intervention program for children with disruptive behaviour disorders. In P. Cotton & H. Jackson, (Eds.), Early intervention & prevention in mental health (pp. 59-85). Melbourne: Australian Psychological Society.Google Scholar
  63. Sanders, M. R., & Markie-Dadds, C. (1997). Managing common child behaviour problems. In M. R. Sanders, C. Mitchell, & G. J. A. Byrne (Eds.), Medical consultation skills: Behavioural and interpersonal dimensions of health care (pp. 356-402). Melbourne: Addison-Wesley-Longman.Google Scholar
  64. Sanders, M. R., Markie-Dadds, C., Tully, L., & Bor, B. (1999). The Triple P-Positive Parenting Program: A comparison of enhanced, standard and self-directed behavioral family intervention for parents of children with early onset conduct problems. Manuscript submitted for publication.Google Scholar
  65. Sanders, M. R., & McFarland, M. L. (1991). The treatment of depressed mothers with disruptive children: A controlled evaluation of cognitive behavioural family intervention. Behavior Therapy. Manuscript submitted for publication.Google Scholar
  66. Sanders, M. R., Montgomery, D. T., & Brechman-Toussaint, M. L. (1999). The mass media and child behaviour problems: The effect of a television series on child and parent outcomes. Unpublished manuscript, University of Queensland at St Lucia.Google Scholar
  67. Sanders, M. R., Nicholson, J. M., & Floyd, F. J. (1997). Couples' relationships and children. In W. K. Halford, & H. J. Markman (Eds.), Clinical handbook of marriage and couples interventions (pp. 225-253). Chichester, U.K.: Wiley.Google Scholar
  68. Sanders, M. R., & Plant, K. (1989). Generalization effects of behavioural parent training to high and low risk parenting environments. Behavior Modification, 13, 283-305.Google Scholar
  69. Sanders, M. R., Shepherd, R. W., Cleghorn, G., & Woolford, H. (1994). The treatment of recurrent abdominal pain in children. A controlled comparison of cognitive-behavioural family intervention and standard pediatric care. Journal of Consulting and Clinical Psychology, 62, 306-314.Google Scholar
  70. Sanders, M. R., Tully, L. A., Baade, P., Lynch, M. E., Heywood, A., Pollard, G., & Youlden, D. (in press). Living with children: A survey of parenting practices in Queensland. Brisbane, Australia: School of Psychology, University of Queensland and Epidemiology Services, Queensland Health.Google Scholar
  71. Sanders, M. R., Turner, K. M. T., & Markie-Dadds, C. (1996). Triple P tip sheet series for primary schoolers. Brisbane, Australia: Families International Publishing.Google Scholar
  72. Schreibman, L., Kaneko, W. M., & Koegel, R. L. (1991). Positive affect of parents of autistic children: A comparison across two teaching techniques. Behavior Therapy, 22, 479-490.Google Scholar
  73. Serketich, W. J., & Dumas, J. E. (1996). The effectiveness of behavioral parent training to modify antisocial behavior in children: A meta-analysis. Behavior Therapy, 27, 171-186.Google Scholar
  74. Sorensen, G., Emmons, K., Hunt, M., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.Google Scholar
  75. Taylor, T. K., & Biglan, A. (1998). Behavioral family interventions for improving child-rearing: A review of the literature for clinicians and policy makers. Clinical Child and Family Psychology Review, 1, 41-60.Google Scholar
  76. Triggs, E. G., & Perrin, E. C. (1989). Listening carefully: Improving communication about behavior and development: Recognizing parental concerns. Clinical Pediatrics, 28(4), 185-192.Google Scholar
  77. Turner, K. M. T., Markie-Dadds, C., & Sanders, M. R. (1996). Triple P tip sheet series for toddlers. Brisbane, Australia: Families International Publishing.Google Scholar
  78. Turner, K. M. T., Markie-Dadds, C., & Sanders, M. R. (1997). Facilitator's manual for group triple p. Brisbane, Australia: Families International Publishing.Google Scholar
  79. Turner, K. M. T., Sanders, M. R., & Markie-Dadds, C. (1996). Triple P tip sheet series for preschoolers. Brisbane, Australia: Families International Publishing.Google Scholar
  80. Turner, K. M. T., Sanders, M. R., & Wall, C. R. (1994). Behavioural parent training versus dietary education in the treatment of children with persistent feeding difficulties. Behaviour Change, 11, 242-258.Google Scholar
  81. Webster-Stratton, C. (1989). Systematic comparison of consumer satisfaction of three cost effective parent training programs for conduct problem children. Behavior Therapy, 20, 103-115.Google Scholar
  82. Webster-Stratton, C. (1994). Advancing videotape parent training: A comparison study. Journal of Consulting and Clinical Psychology, 62, 583-593.Google Scholar
  83. Webster-Stratton, C. (1997). From parent training to community building. Families in Society, 78(2), 156-171.Google Scholar
  84. Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93-109.Google Scholar
  85. Wesch, D., & Lutzker, J. R. (1991). A comprehensive 5-year evaluation of Project 12-Ways: An ecobehavioral program for treating and preventing child abuse and neglect. Journal of Family Violence, 6(1), 17-35.Google Scholar
  86. White, B. L. (1990). The first three years of life. New York: Prentice-Hall.Google Scholar
  87. Williams, A., Zubrick, S., Silburn, S., & Sanders, M. (1997). A population based intervention to prevent childhood conduct disorder: The Perth Positive Parenting Program demonstration project. Paper presented at the Ninth National Health Promotion Conference, Darwin, Northern Territory, Australia.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Matthew R. Sanders

There are no affiliations available

Personalised recommendations