BOX 6-3

Triple P: A Multilevel Parenting Intervention

The Positive Parenting Program (Triple P) focuses on the general population, not just individual families, and has selected components tailored to at-risk groups (such as young single mothers) or children with behavioral problems. The program includes five levels of parenting guidance based on family needs and preferences. The universal level provides information via mass media about effective parenting and solutions to common childrearing problems. The second level provides brief advice to parents for dealing with specific concerns, such as toileting or bedtime problems; parents are typically reached through contact with primary health care providers, such as pediatricians. The third level provides skills training for parents who are having problems with children’s aggressive or uncooperative behavior. The fourth level (standard Triple P) provides up to 12 one-hour sessions on parenting skills for parents whose children have multiple behavioral problems, particularly aggressive behavior. The final level, enhanced Triple P, provides skills and support to deal with parental depression, marital discord, or other family challenges.

Sanders, Markie-Dadds, et al. (2000) evaluated three variants of Triple P (enhanced Triple P, standard Triple P, and self-directed training) and a wait-list condition with families of preschoolers who were at risk of developing conduct problems. The two practitioner-assisted interventions were more effective than the self-directed training or the wait-list condition. At one-year follow-up, all three active intervention conditions had similar levels of change in directly observed disruptive behavior. Another randomized controlled evaluation of standard Triple P and enhanced Triple P likewise showed positive effects (Ireland, Sanders, and Markie-Dadds, 2003). Sanders, Pidgeon, and colleagues (2004) tested an enhanced version of Triple P that had an additional component to help parents deal with anger problems. This trial also demonstrated significant benefits.

A randomized controlled study of the mass media component of Triple P (Sanders, Montgomery, and Brechman-Toussaint, 2000) indicated that children of parents who watched a 12-episode television series had significantly lower levels of disruptive behavior (based on parental reports), and parents expressed higher levels of competence. Prinz, Sanders, and colleagues (2009) recently reported a randomized trial of Triple P in 18 South Carolina counties that was accompanied by a media campaign. This study is noteworthy for being the first to show significant positive effects of a parenting intervention in an entire population.

Early Adolescence

Early adolescence is a developmental period during which the prevalence of substance use, delinquency, and depression begins to rise. There is also evidence of an increase in the rates of teasing and harassment in middle school. Significant physical changes occur with the onset of puberty, along with social changes, including the transition from elementary school



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