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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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.
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.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.
Bandura, A. (1995). Self-efficacy in changing societies. New York: Cambridge University Press.
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.
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.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
Biglan, A. (1992). Family practices and the larger social context. New Zealand Journal of Psychology, 21(1), 37-43.
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.
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.
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.
Christopherson, E. R. (1982). Incorporating behavioral pediatrics into primary care. Pediatric Clinics of North America, 29, 261-295.
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.
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.
Cummings, E. M., & Davies, P. (1994). Children and marital conflict: The impact of family dispute and resolution. New York: Guilford.
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.
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.
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.
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.
Dryfoos, J. G. (1990). Adolescents at risk: Prevalence and prevention. New York: Oxford University Press.
Emery, R. E. (1982). Interparental conflict and the children of discord and divorce. Psychological Bulletin, 92, 310-330.
Fixsen, D. L., & Blase, K. A. (1993). Creating new realities: Program development and dissemination. Journal of Applied Behavior Analysis, 26, 597-615.
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.
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.
Grych, J. H., & Fincham, F. D. (1990). Marital conflict and children's adjustment: A cognitive-contextual framework. Psychological Bulletin, 108, 267-290.
Hart, B., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis, 8, 411-420.
Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Baltimore: Paul H. Brookes.
Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52.
Kazdin, A. E. (1987). Treatment of antisocial behaviour in children: Current status and future directions. Psychological Bulletin, 102, 187-203.
Lawton, J. M., & Sanders, M. R. (1994). Designing effective behavioral family interventions for stepfamilies. Clinical Psychology Review, 14, 463-496.
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.
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.
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.
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.
Markie-Dadds, C., Sanders, M. R., & Turner, K. M. T. (1999). Every parent's self-help workbook. Brisbane, Australia: Families International Publishing.
Markie-Dadds, C., Turner, K. M. T., & Sanders, M. R. (1998). Triple P tip sheet series for infants. Brisbane, Australia: Families International Publishing.
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.
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.
Meichenbaum, D. (1974). Self-instructional strategy training: A cognitive prothesis for the aged. Human Development, 17, 273-280.
Mrazek, P., & Haggerty, R. J. (1994). Reducing the risks for mental disorders. Washington, DC: National Academy Press.
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.
Neilson, A. C. (1997). People Meter Rating Analysis. Sydney, Australia: Author.
Nicholson, J. M., & Sanders, M. R. (1999). Behavioural family intervention with children living in step families. Manuscript submitted for publication.
Patterson, G. R. (1982). Coersive family process. Eugene, OR: Castalia.
Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys. Eugene, OR: Castalia.
Peterson, L., & Saldana, L. (1996). Accelerating children's risk for injury: Mothers' decisions regarding common safety rules. Journal of Behavioral Medicine, 19, 317-331.
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.
Robins, L. N. (1991). Conduct disorder. Journal of Child Psychology and Psychiatry, 32, 193-212.
Rutter, M. (1985). Family and school influences on behavioral development. Journal of Child Psychology and Psychiatry, 26, 349-368.
Sanders, M. R. (1992a). Enhancing the impact of behavioural family intervention with children: Emerging perspectives. Behaviour Change, 9(3), 115-119.
Sanders, M. R. (1992b). Every parent: A positive approach to children's behaviour. Sydney, Australia: Addison Wesley.
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.
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.
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.
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.
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.
Sanders, M. R., & Dadds, M. R. (1993). Behavioral family intervention. Boston: Allyn and Bacon.
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.
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.
Sanders, M. R., Lynch, M., & Markie-Dadds, C. (1994). Everyparent's workbook: A positive guide to positive parenting. Brisbane, Australia: Australian Academic Press.
Sanders, M. R., Markie-Dadds, C., & Turner, K. M. T. (1999). Practitioner's manual for Enhanced Triple P. Brisbane, Australia: Families International Publishing.
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.
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.
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.
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.
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.
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.
Sanders, M. R., & Plant, K. (1989). Generalization effects of behavioural parent training to high and low risk parenting environments. Behavior Modification, 13, 283-305.
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.
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.
Sanders, M. R., Turner, K. M. T., & Markie-Dadds, C. (1996). Triple P tip sheet series for primary schoolers. Brisbane, Australia: Families International Publishing.
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.
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.
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.
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.
Triggs, E. G., & Perrin, E. C. (1989). Listening carefully: Improving communication about behavior and development: Recognizing parental concerns. Clinical Pediatrics, 28(4), 185-192.
Turner, K. M. T., Markie-Dadds, C., & Sanders, M. R. (1996). Triple P tip sheet series for toddlers. Brisbane, Australia: Families International Publishing.
Turner, K. M. T., Markie-Dadds, C., & Sanders, M. R. (1997). Facilitator's manual for group triple p. Brisbane, Australia: Families International Publishing.
Turner, K. M. T., Sanders, M. R., & Markie-Dadds, C. (1996). Triple P tip sheet series for preschoolers. Brisbane, Australia: Families International Publishing.
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.
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.
Webster-Stratton, C. (1994). Advancing videotape parent training: A comparison study. Journal of Consulting and Clinical Psychology, 62, 583-593.
Webster-Stratton, C. (1997). From parent training to community building. Families in Society, 78(2), 156-171.
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.
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.
White, B. L. (1990). The first three years of life. New York: Prentice-Hall.
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.
About this article
Cite this article
Sanders, M.R. 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. Clin Child Fam Psychol Rev 2, 71–90 (1999). https://doi.org/10.1023/A:1021843613840
- family intervention