Implementing Triple P - Positive Parenting Program^®—Variants suitable for home visiting

Triple P – Positive Parenting Program^® (Triple P) is a parenting and family support system that serves families with children from birth through age 16. The system includes multiple interventions that increase in intensity across five levels of service. Within each level, there is a range of delivery methods to meet different family needs and be appropriate for multiple cultures. Home visiting is one of the methods of delivering services within some levels.

No Triple P level or intervention is exclusively delivered in the home with families with children from birth through age 5. This profile is based on (1) studies of programs that provided Triple P services in the home to families with children from birth through age 5, and (2) developer input on the Triple P interventions suitable for delivery in the home with families with children from birth through age 5. HomVEE refers to the approach to delivering Triple P in the home with families with children birth through age 5 as Triple P–Variants suitable for home visiting*.

Triple P was developed by researchers at The University of Queensland’s Parenting and Family Support Centre in Australia. Triple P is licensed under Triple P International Pty Ltd (TPI), based in Brisbane, Australia. TPI publishes Triple P resources, supports implementation, and provides training and accreditation. TPI subsidiary offices operate in many countries. In the United States, Triple P America’s implementation consultants support local and state government agencies and community-based organizations through all stages of implementation, including planning, training, delivery, evaluation, and sustainability.

*In this profile, when a description or requirement is specific to delivering Triple P in the home with families with children from birth through age 5, the profile specifies that, such as by saying: “when delivering Triple P in the home…”. Otherwise, if a description or requirement applies to Triple P interventions across all settings, service delivery methods, and target populations, the profile says “Triple P…”.

Triple P draws on social learning theory, cognitive behavioral development, and research on the risk factors associated with social and behavioral problems in children.

The system’s five levels are organized by the degree of parental need or child behavioral difficulties. Intensity ranges from Level 1, a population-wide communication strategy, to Level 5, which addresses issues that complicate parenting such as partner conflict, stress, mental illness, risk of child maltreatment, and anger management. Below is a brief description of each level, including whether home visiting can be used as a service delivery method.

• Levels 1 and 2 do not involve home visiting.
  • Level 1 is a community-wide communications strategy designed to promote the importance of parenting and raise awareness of parenting needs throughout a community.
  • Level 2 provides parents with minor concerns about their child’s behavior or development brief parenting advice through a one-time parenting seminar or consultation.
• Levels 3 through 5 can involve home visiting.
  • Level 3 provides narrowly focused parenting skills training targeting a specific behavioral problem or issue through face-to-face or telephone sessions with a practitioner or small group sessions. The Triple P interventions offered at this level include Primary Care Triple P and Triple P Discussion Groups.
  • Level 4 provides broadly focused parenting skills training. This level offers four interventions: (1) Group Triple P, involving group sessions and phone or home-based sessions; (2) Standard Triple P, involving individual counseling sessions for parents who require intensive support; (3) Triple P Online, a web-based curriculum; and (4) Self-Help Triple P, a self-help workbook with phone consultations.
  • Level 5 provides more intensive family interventions that support parents who face complex parenting issues. The Level 5 interventions include (1) Enhanced Triple P for parents experiencing partner conflict, stress, or mental health issues, and (2) Pathways Triple P, which provides behavioral strategies for parents at risk of child maltreatment. Parents must participate in a Level 4 intervention before or in conjunction with Enhanced or Pathways Triple P.

Implementing agencies select the intensity, intervention, and delivery setting that reflects their organization’s priorities and budgets. For example, agencies can implement multiple Triple P interventions across levels to reach an entire population or select a Triple P intervention designed for a particular parenting group or demographic.

The following Triple P interventions are suitable for delivery in the home: Primary Care Triple P (Level 3), Standard Triple P (Level 4), Enhanced Triple P (Level 5), and Pathways Triple P (also Level 5).

Triple P also includes five adaptations for certain subgroups: (1) Stepping Stones Triple P for families with children with a disability, (2) Family Transitions Triple P for families in which parents are going through separation or divorce and have concerns about their children’s behavior, (3) Indigenous Triple P for indigenous families with children from birth through age 12, (4) Group Lifestyle Triple P for families with parents concerned about their children’s overweight or obesity and activity level, and (5) Teen Triple P for parents of teenagers through age 16. Family Transitions Triple P, Indigenous Triple P, and some versions of Stepping Stones Triple P (described in Adaptations and Enhancements) also are suitable for delivery in the home.

The Triple P interventions that can be delivered in the home mainly serve families with children from birth through age 16 who experience behavioral and emotional problems. For the purposes of the HomVEE review, this profile is based on: (1) studies of programs that served families with children from birth through age 5, and (2) developer input on the Triple P interventions suitable for families with children from birth through age 5.

Triple P is designed to prevent and treat the behavioral and emotional problems of children and teenagers. The system aims to equip parents with the skills and confidence they need to manage family issues without ongoing support.

Regardless of the setting, service delivery method, or target population, all Triple P interventions teach parents strategies focused on developing positive relationships, attitudes, and conduct with children to improve behavioral problems. However, the type and intensity of services when delivering Triple P in the home vary based on the degree of parental need or child behavioral difficulties:

• Primary Care Triple P (Level 3) serves parents with children with mild or moderate behavioral difficulties. It provides parenting strategies via home visiting focused on a specific behavioral problem or issue, face to face or by telephone.

• Standard Triple P (Level 4) offers individual counseling to parents of children with more severe behavioral difficulties who need more intensive support. This intervention includes child management training, which shows parents how they can help teach their children new behaviors using strategies such as descriptive praise and contingent consequences. The practitioner provides verbal and written instruction and models behavior in an effort to teach parents steps intended to modify their child’s behavior. Then, the practitioner observes parent–child interactions and provides verbal feedback and written enrichment materials. It also includes planned activities training, which teaches parents planning strategies for managing children’s behavior in challenging situations and settings such as mealtimes or shopping trips.
• Enhanced Triple P (Level 5) includes up to four modules for parents that target specific concerns and seek to address partner relationships and communication, personal coping strategies for high-stress situations, and positive parenting practices.

• Pathways Triple P (Level 5) serves parents at risk of committing child maltreatment and covers anger management and other behavioral strategies to improve a parent’s ability to cope with raising children.

The intensity and length of the Triple P interventions suitable for delivery in the home vary:

• Primary Care Triple P (Level 3)—approximately four consultations of 15 to 30 minutes each; 
• Standard Triple P (Level 4)—10 one-hour sessions; 
• Enhanced Triple P (Level 5)—approximately eight sessions, each lasting 60 to 90 minutes; and 
• Pathways Triple P (Level 5)—approximately five sessions, each lasting 60 to 90 minutes.

The recommended frequency of sessions is one per week.

Triple P has been implemented in more than 25 countries. In the United States, Triple P practitioners are located in nearly all 50 states. Triple P variants are delivered in the home in at least two states: California and Kansas.

Triple P can be tailored to different delivery settings, practitioners, and populations. Practitioners are trained to apply Triple P processes and strategies in different ways to a range of presenting behavioral and emotional problems and family circumstances.

In addition, three Triple P adaptations have versions suitable for delivery in the home with families with children from birth through age 5:

1. Stepping Stones Triple P is designed for parents with children with disabilities. It provides an assessment of parenting strategies and then instruction and support that aim to promote child competencies in social and language skills, emotional skills, independence, and problem solving. There are two versions of Stepping Stones suitable for delivery in the home with children from birth through age 5: Primary Care Stepping Stones (Level 3), which offers four individual consultations of 15 to 30 minutes each, and Standard Stepping Stones (Level 4), which offers 10 one-hour sessions. Triple P International Pty Ltd (TPI) estimates that one full-time equivalent practitioner can see approximately 50 families per year when delivering Primary Care Stepping Stones, and 25 families per year when delivering Standard Stepping Stones.  
2. Family Transitions Triple P is designed for parents whose separation or divorce has complicated parenting. Practitioners help parents adjust to their separation or divorce, and to foster conflict resolution skills and stress management. The intervention includes weekly two-hour sessions for five weeks. Family Transitions Triple P is provided in addition to a Level 4 Triple P intervention. TPI estimates that one full-time equivalent practitioner can see approximately 25 families per year.  
3. Indigenous Triple P is designed for indigenous families with children from birth through age 12. The intervention involves six sessions of individual home visits and telephone counseling sessions. Indigenous Triple P is primarily used in Australia, Canada, and New Zealand.

The information contained on this page was last updated in August 2019. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Triple P America office on August 5, 2019. HomVEE reserves the right to edit the profile for clarity and consistency.