Level 4 Group Triple P
Level 4 Group Triple P is a targeted-indicated intervention for parents with a child between 0 and 12 years old who have concerns about their child’s behaviour.
Groups of up to 12 parents attend sessions over eight weeks delivered by a single trained and supervised clinical psychologist. These sessions include five two-hour group meetings, as well as three individual telephone consultations lasting 15 to 30 minutes.
Parents learn 17 different strategies for improving their children’s competencies and discouraging unwanted child behaviour. Role play, homework exercises and discussions involving video-taped examples of effective parenting strategies are used to help parents learn methods for dealing with unwanted child behaviour and supporting their child’s emotional needs.
EIF Programme Assessment
Level 4 Group Triple P has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.
What does the evidence rating mean?
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
What does the plus mean?
The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.
Whilst this Guidebook page describes Level 4 Group Triple P when implemented on a targeted basis (with children where there are concerns about their behaviour), it is also possible to deliver this programme on a universal basis. Evaluations investigating the impact of the programme when delivered universally have identified both positive and more equivocal findings. For instance, an RCT assessing the universal programme implemented in preschools in Germany (Heinrichs et al., 2017) provides preliminary evidence of positive impact on child behaviour. Another implementation conducted in primary schools in Switzerland (Bodenmann et al., 2008) also provides preliminary evidence of positive impact on child behaviour, yet, another analysis of this trial (Eisner et al., 2012) suggests that for those completing the full programme (i.e. attending all 5 sessions) there was no effect.
A rating of 1 indicates that a programme has a low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of less than £100.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Preventing crime, violence and antisocial behaviour
Improved behaviour - based on,
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Level 4 Group Triple P
Key programme characteristics
Who is it for?
The best available evidence for this programme relates to the following age-groups:
- Primary school
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Children's centre or early-years setting
- Out-patient health setting
The programme may also be delivered in these settings:
- Primary school
- Community centre
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted indicated
Where has it been implemented?
Argentina, Australia, Belgium, Canada, England, France, Germany, Hong Kong, Ireland, Japan, Mexico, Netherlands, New Zealand, Romania, Scotland, Singapore, Sweden, Switzerland, United Kingdom, United States, Wales
This programme has been implemented in the UK.
This programme’s best evidence does not include evaluation conducted in the UK.
EIF does not currently include this programme within any Spotlight set.
Level 4 Group Triple P
About the programme
What happens during delivery?
How is it delivered?
- Level 4 Group Triple P is delivered by a Triple P practitioner in five sessions of approximately two hours’ duration to groups of up to 12 families. An additional three sessions (between 15 and 30 minutes each) are delivered to individual families via telephone.
What happens during the intervention?
- Parents learn 17 different strategies for improving their children’s competencies and discouraging unwanted child behaviour.
- Learning is supported through role play exercises, homework exercises and group discussions involving video-taped examples of effective parenting strategies.
What are the implementation requirements?
Who can deliver it?
- The practitioner who delivers this programme is a Triple P practitioner, who can come from a range of professions (eg family support worker) with recommended minimum QCF-4/5 level qualifications.
What are the training requirements?
The practitioner has three days of programme training. This includes one day of pre-accreditation, and a half-day accreditation workshop (accreditation workshops are held over two days; practitioners attend in groups of five). Booster training of practitioners is not required.
How are the practitioners supervised?
- It is recommended that practitioners are supervised by one host-agency supervisor with QCF-7/8 level qualifications, with no required programme training.
What are the systems for maintaining fidelity?
- Accreditation process
- Training manual
- Fidelity monitoring
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Triple P is based on the idea that parents often unintentionally perpetuate unwanted child behaviour through ineffective parenting strategies.
- Triple P helps parents replace ineffective parenting strategies with effective methods for encouraging positive child behaviour.
- In the short term, parents learn more effective strategies for managing their child’s behaviour and the child’s behaviour improves.
- In the longer term, children should have greater self-regulatory skills and self-confidence and do better in school.
- It is also expected that children will be less likely to have behavioural problems and/or engage in antisocial behaviour.
Supporting children's mental health and wellbeing
Preventing child maltreatment
Enhancing school achievement & employment
Preventing crime, violence and antisocial behaviour
Triple P corporate website
Commissioning Toolkit Programme Overview
Investing In Children Programme Overview (all levels)
Investing In Children Programme Overview (Level 4, Group)
Investing In Children Programme Overview (Level 4, Individual)
Triple P training info
Triple P cost-effectiveness info
Level 4 Group Triple P
About the evidence
Level 4 Group Triple P's most robust evidence comes from two RCTs conducted in China.
|Citation:||Leung et al. (2003)|
|Sample:||91 middle-class families living in Hong Kong|
|Child outcomes:||Improved behaviour|
|Other outcomes:||Improved parenting
Improved relationship satisfaction
Leung, C., Sanders, M. R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.
|Citation:||Chung et al. (2015)|
|Sample:||91 middle-class families living in Hong Kong|
|Child outcomes:||Improved behaviour|
|Other outcomes:||None measured|
Chung, S., Leung, C., & Sanders, M. R. (2015). The Triple P – Positive Parenting Program: The effectiveness of group Triple P and brief parent discussion group in school settings in Hong Kong. Journal of Children’s Services, 10, 1-14.
The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies.
Aghebati, A., Gharraee, B., Hakim Shoshtari, M., & Gohari, M. R. (2014). Triple P-Positive Parenting Program for mothers of ADHD children. Iran J Psychiatry Behav Sci, 8(1), 59-65.
Ashori, M., Afrooz, G., Arjmandnia, A., Pourmohamadreza-Tajrishi, M., & Ghobri-Bonab, B. (2015). The Effectiveness of Group Positive Parenting Program (Triple-P) on the Mother-Child Relationships With Intellectual Disability. Iran J Public Health, 44(2), 290-291.
Au, A., Lau, K.-M., Wong, A. H.-C., Lam, C., Leung, C., Lau, J., & Lee, Y. K. (2014). The Efficacy of a Group Triple P (Positive Parenting Program) for Chinese Parents with a Child Diagnosed with ADHD in Hong Kong: A Pilot Randomised Controlled Study. Australian Psychologist, 49(3), 151-162. doi:10.1111/ap.12053
Averdijk, M., Zirk-Sadowski, J., Ribeaud, D., & Eisner, M. (2016). Long-term effects of two childhood psychosocial interventions on adolescent delinquency, substance use, and antisocial behavior: a cluster randomized controlled trial. Journal of Experimental Criminology. doi:10.1007/s11292-015-9249-4
Bodenmann, G., Cina, A., Ledermann, T., & Sanders, M. R. (2008). The efficacy of the Triple P-Positive Parenting Program in improving parenting and child behavior: A comparison with two other treatment conditions. Behaviour Research and Therapy, 46(4), 411-427. doi:10.1016/j.brat.2008.01.001
Cann, W., Rogers, H., & Matthews, J. (2003). Family Intervention Services program evaluation: A brief report on initial outcomes for families. Australian e-Journal for the Advancement of Mental Health, 2(3). doi:10.5172/jamh.2.3.208
Chan, S., Leung, C., & Sanders, M. R. (2016). A randomised controlled trial comparing the effects of directive and non-directive parenting programmes as a universal prevention programme. J Child Serv, 11, 38-53. doi:10.1108/JCS-08-2014-0038
Cina, A., Ledermann, T., Meyer, J., Gabriel, B., & Bodenmann, G. (2004). Triple P in der Schweiz: Zufriedenheit, Akzeptanz und Wirksamkeit (No. 162) [Triple P in Switzerland: Satisfaction, acceptance, and effectiveness]. Retrieved from Institute for Family Research and Counseling, University of Fribourg, Switzerland
Crisante, L., & Ng, S. (2003). Implementation and process issues in using Group Triple P with Chinese parents: Preliminary findings. Australian e-Journal for the Advancement of Mental Health, 2(3). doi:10.5172/jamh.2.3.226
de Graaf, I., Haverman, M., Onrust, S., & Tavecchio, L. (2009). Improving parenting and its impact on parental psychopathology: Trial of the Triple P Positive Parenting Program.
Dean, C., Myors, K., & Evans, E. (2003). Community-wide implementation of a parenting program: The South East Sydney Positive Parenting Project. Australian e-Journal for the Advancement of Mental Health, 2(3). doi:10.5172/jamh.2.3.179
Doyle, O., Delaney, L., O’Farrelly, C., Fitzpatrick, N., & Daly, M. (2017). Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial. PLoS ONE, 12, e0169829. doi:0.1371/journal.pone.0169829
Eichelberger, I., Pluck, J., Hanish, C., Hautmann, C., Janen, N., & Dopfner, M. (2010). Effekte universeller Pravention mit dem Gruppenformat des Eltern-trainings Triple P auf das kindliche Problemverhalten, das elterliche Erziehungsverhalten und die psychische Belastung der Eltern. Zeitschrift fuer Klinische Psychologie und Psychotherapie, 39(1), 24-32.
Eisner, M., Nagin, D., Ribeaud, D., & Malti, T. (2012). Effects of a universal parenting program for highly adherent parents: a propensity score matching approach. Prevention Science, 13(3), 252-266.
Eisner, M., Ribeaud, D., Juenger, R., & Meidert, U. (2007). Die umsetzung von Triple P. [The implementation of Triple P] Fruehpraevention von Gewalt und Aggression: Ergebnisse des Zuercher Praeventions- und Interventionsprojektes an Schulen. [Early prevention of violence and aggression. Results from the Zurich prevention and intervention project at schools]. Zuerich: Ruegger Verlag
Fawley-King, K., Trask, E., Calderon, N. E., Aarons, G. A., & Garland, A. F. (2014). Implementation of an evidence-based parenting programme with a Latina population: Feasibility and preliminary outcomes. J Child Serv, 9(4), 295-306. doi:10.1108/JCS-04-2014-0024
Fives, A., Pursell, L., Heary, C., Nic Gabhainn, S., & Canavan, J. (2014). Evaluation of the Triple P programme in Longford and Westmeath. Retrieved from Athlone
Frank, T. J., Keown, L. J., & Sanders, M. R. (2015). Enhancing father engagement and intraparental teamwork in an evidence-based parenting intervention: A randomized controlled trial of outcomes and processess. Behaviour Therapy. doi:10.1016/j.beth.2015.05.008
Fujiwara, T., Kato, N., & Sanders, M. R. (2011). Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior, Parenting Style, and Parental Adjustment: An Intervention Study in Japan. Journal of Child and Family Studies, 20(6), 804-813. doi:10.1007/s10826-011-9448-1
Gallart, S. C., & Matthey, S. (2005). The effectiveness of Group Triple P and the impact of the four telephone contacts. Behaviour Change, 22(2), 71-80. doi:10.1375/bech.2005.22.2.71
Glazemakers, I. (2012). A population health approach to parenting support: Disseminating the Triple P-Positive Parenting Program in the province of Antwerp. ((Unpublished doctoral thesis)), Universiteit Antwerpen, Antwerp, Belgium
Glazemakers, I., & Deboutte, D. (2013). Modifying the 'Positive Parenting Program' for parents with intellectual disabilities. Journal of Intellectual Disability Research. doi:doi: 10.1111/j.1365-2788.2012.01566
Golley, R. K., Magarey, A. M., Baur, L. A., Steinbeck, K. S., & Daniels, L. A. (2007). Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: A randomized, control trial. Pediatrics, 119(3), 517-525. doi:10.1542/peds.2006-1746
Guo, M. (2015). An evaluation of the Triple P - Positive Parenting Program with Chinese parents in mainland China with a look into the effects on children’s academic outcomes. The University of Queensland.
Hahlweg, K., Heinrichs, N., Kuschel, A., Bertram, H., & Naumann, S. (2010). Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort? Child & Adolescent Psychiatry and Mental Health, 4(1-14).
Hedges, S. (2014). Jewish Family Service Positive Parenting Program Evaluation Report Fiscal Year 2013-2014.
Heinrichs, N., Hahlweg, K., Bertram, H., Kuschel, A., Naumann, S., & Harstick, S. (2006). Die langfristige Wirksamkeit eines Elterntrainings zur universellen Praevention kindlicher Verhaltensstoerungen: Ergebnisse aus Sicht der Muetter und Vaeter [Long term effectiveness of a parent training for universal prevention of child behavior disorders]. Zeitschrift fuer Klinische Psychologie und Psychotherapie, 35, 72-86
Heinrichs, N., Hahlweg, K., Naumann, S., Kuschel, A., Bertram, H., & Stander, D. (2009). Universelle prävention kindlicher verhaltensstörungen mithilfe einer elternzentrierten maßnahme: Ergebnisse drei Jahre nach teilnahme. / Universal prevention of child behavior problems with a parent training. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 38(2), 79-88
Heinrichs, N., & Jensen-Doss, A. (2010). The effects of incentives on families' long-term outcome in a parenting program. Journal of Clinical Child & Adolescent Psychology, 39(5), 705-712. doi:10.1080/15374416.2010.501290
Heinrichs, N., Kliem, S., & Hahlweg, K. (2014). Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes. Prevention Science, 15(2), 233-245. doi:10.1007/s11121-012-0358-2
Heinrichs, N., Kruger, S., & Guse, U. (2006). Der Einfluss von Anreizen auf die Rekrutierung von Eltern und auf die Effektivitaet eines praeventiven Elterntrainings [The effects of incentives on recruitment rates of parents and the effectiveness of a preventative parent training]. Zeitschrift fuer Klinische Psychologie und Psychotherapie, 35, 97-108
Houlding, C., Schmidt, F., Stern, S. B., Jamieson, J., & Borg, D. (2012). The perceived impact and acceptability of group triple P positive parenting program for aboriginal parents in Canada. Children and Youth Services Review, 34(12), 2287-2294. doi:10.1016/j.childyouth.2012.08.001
Ireland, J. L., Sanders, M. R., & Markie-Dadds, C. (2003). The impact of parent training on marital functioning: A comparison of two group versions of the Triple P-Positive Parenting Program for parents of children with early-onset conduct problems. Behavioural and Cognitive Psychotherapy, 31(2), 127-142. doi:10.1017/s1352465803002017
Kelch-Oliver, K., & Smith, C. O. (2015). Using an evidence-based parenting intervention with African American Parents. The Family Journal: Counselling and Therapy for Couples and Families, 23, 26-32. doi:10.1177/1066480714555697
Kuschel, A., Heinrichs, N., & Hahlweg, K. (2009). Is a preventive parenting program effective in reducing a child's externalizing behavior? European Journal of Developmental Science, 3(3), 299-303.
Ledermann, T., Cina, A., Meyer, J., Gabriel, B., & Bodenmann, G. (2004). Die Wirksamkeit zweier Praeventionsprogramme zur Verbesserung elterlicher Kompetenzen und kindlichen Befindens (No. 163) [The effectiveness of two prevention program for the improvement of parental competencies and child well-being. Retrieved from Switzerland
Leung, C., Fan, A., & Sanders, M. R. (2013). The effectiveness of a Group Triple P with Chinese parents who have a child with developmental disabilities: A randomized controlled trial. Research in Developmental Disabilities, 34, 976-984.
Leung, C., Sanders, M. R., Ip, F., & Lau, J. (2006). Implementation of Triple P-Positive Parenting Program in Hong Kong: Predictors of programme completion and clinical outcomes. Journal of Children’s Services, 1(2), 4-17.
Lindsay, G., & Strand, S. (2013). Evaluation of the national roll-out of parenting programmes across England: the parenting early intervention programme (PEIP). BMC Public Health, 13(1), 972. doi:10.1186/1471-2458-13-972
Lindsay, G., Strand, S., & Davis, H. (2011). A comparison of the effectiveness of three parenting programmes in improving parenting skills, parent mental-well being and children's behaviour when implemented on a large scale in community settings in 18 English local authorities: the parenting early intervention pathfinder (PEIP). BMC Public Health, 11, 962.
Little, M., Berry, V., Morpeth, L., Blower, S., Axford, N., Taylor, R., . . . Tobin, K. (2012). The impact of three evidence-based programmes delivered in public systems in Birmingham, UK. International Journal of Conflict and Violence, 6(2), 260-272. doi:0070-ijcv-2012293
Magarey, A. M., Perry, R. A., Baur, L. A., Steinbeck, K. S., Sawyer, M., Hills, A. P., . . . Daniels, L. A. (2011). A parent-led family-focused treatment program for overweight children aged 5 to 9 years: The PEACH RCT. Pediatrics, 127(2), 214-222. doi:10.1542/peds.2009-1432
Malti, T., Ribeaud, D., & Eisner, M. (2011). The effectiveness of two universal preventive interventions in reducing children's externalizing behavior: a cluster randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 40(5), 677-692.
Marryat, L., Thompson, L., Barry, S., McGranachan, M., Sim, F., White, J., Wilson, P. (2014). Parenting Support Framework Evaluation: Year 1 Report.
Masters, G., Gaven, S., Pennington, A., & Askew, L. (2011). Evaluation of the Implementation of Triple P in NSW. (Unpublished report).
Matsumoto, Y., Sofronoff, K., & Sanders, M. R. (2007). The efficacy and acceptability of the Triple P-Positive Parenting Program with Japanese parents. Behaviour Change, 24(4), 205-218. doi:10.1375/bech.24.4.205
Matsumoto, Y., Sofronoff, K., & Sanders, M. R. (2010). Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society. Journal of Family Psychology, 24(1), 87-91. doi:10.1037/a0018181
McTaggart, P., & Sanders, M. R. (2003). The Transition to School Project: Results from the classroom. Australian e-Journal for the Advancement of Mental Health, 2(3). doi:10.5172/jamh.2.3.144
McTaggart, P., & Sanders, M. R. (2005). The transition to school project: A controlled evaluation of a universal population trial of the Triple P Positive Parenting Program. Unpublished manuscript.
Moharreri, F., Shahrivar, Z., Tehrani-doost, M., & Mahmoudi-Gharaei, J. (2008). Efficacy of the Positive Parenting Program (Triple P) for parents of children with Attention Deficit/Hyperactivity Disorder. Iranian Journal of Psychiatry, 3, 59-63
Naumann, S., Kuschel, A., Bertram, H., Heinrichs, N., & Hahlweg, K. (2007). Förderung der elternkompetenz durch Triple P-Elternrainings. / Promotion of parental competence with Triple P. Praxis der Kinderpsychologie und Kinderpsychiatrie, 56(8), 676-690
Noorbakhsh, S., Zeinodini, Z., & Rahgozar, F. (2014). Positive Parenting Program (3P) Can Reduce Depression, Anxiety, and Stress of Mothers Who Have Children with ADHD. International Journal of Applied Behavioral Sciences, 1
Onrust, S., de Graaf, I., & van der Linden, D. (2012). De meerwaarde van Triple P: Resultaten van een gerandomiseerde effectstudie van de Triple P gezinsinterventie bij gezinnen met meervoudige problematiek [The added value of Triple P: Results of a randomized clinical trial of the Triple P family intervention with families with multiple problems].
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Penthin, R., Schrader, C., & Mildebrandt, N. (2005). Erfahrungen mit der deutschen Version des Triple P-Elterntrainings bei Familien mit und ohne ADHS-Problematik [Experiences with the German version of Triple P parent training with families with and without ADHS problems]. Zeitschrift fuer Heilpaedigogik, 5(186-192)
Pouretemad, H., Khooshabi, K., Roshanbin, M., & Jadidi, M. (2009). The effectiveness of Group Positive Parenting Program on parental stress of mothers of children with Attention-Deficit/Hyperactivity Disorder. Archives of Iranian Medicine, 12(1), 60-68
Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12. doi:10.1007/s11121-009-0123-3
Propp, O., Müller, M., & Kliem, S. (2013). Erziehungstraining für eltern mit einer psychischen erkrankung—Eine pilotstudie. [Educational skills training for parents with mental illness.]. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 42(2), 118-126. doi:10.1026/1616-3443/a000194
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Rogers, H., Cann, W., Cameron, D., Littlefield, L., & Lagioia, V. (2003). Evaluation of the Family Intervention Service for children presenting with characteristics associated with Attention Deficit Hyperactivity Disorder. Australian e-Journal for the Advancement of Mental Health, 2(3). doi:10.5172/jamh.2.3.216
Salmon, K., Dittman, C. K., Sanders, M. R., Burson, R., & Hammington, J. (2014). Does adding an emotion component enhance the Triple P−Positive Parenting Program? Journal of Family Psychology, 28(2), 244-252. doi:10.1037/a0035997
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Tellegen, C. L., & Johnston, E. (2016). A Service-Based Evaluation of the Effectiveness of an All-Day Group Triple P-Positive Parenting Program. Journal of Child and Family Studies. doi:10.1007/s10826-016-0630-3
Tully, L. A., & Hunt, C. (2016). A randomized controlled trial of a brief versus standard group parenting program for toddler aggression. Aggressive Behavior, 9999, 1-13. doi:10.1002/ab.21689
Wakimizu, R., & Fujioka, H. (2015). Strengthening positive parenting through a 2-month intervention in a local city in Japan: evaluating parental efficacy, family adjustment, and family empowerment. European Journal for Person Centered Healthcare, 3
Wakimizu, R., Fujioka, H., Iejima, A., & Miyamoto, S. (2014). Effectiveness of the group-based positive parenting program with Japanese families raising a child with developmental disabilities: A longitudinal study. Journal of Psychological Abnormalities in Children, 3, 1-9. doi:10.4172/2329-9525.1000113
Winter, L., Morawska, A., & Sanders, M. R. (2011). The effect of behavioral family intervention on knowldege of effective parenting strategies. Journal of Child and Family Studies. doi:10.1007/s10826-011-9548-y
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