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Parenting Research and Practice Monograph No.1 0 1

Parenting Research and Practice Monograph No.1 0 1

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 Address for correspondence: Matthew R. Sanders, Parenting and Family Support Centre, The University of Queensland, St Lucia QLD 4072, AustraliaEmail: m.sanders@psy.uq.edu.auCopyright 2003 The Parenting and Family Support Centre, The University of QueenslandISBN 1 875378 46 4
This paper outlines the theoretical, empirical and clinical foundations of a unique parenting and family supportstrategy designed to reduce the prevalence of behavioural and emotional problems in children and adolescents.The program known as the Triple P-Positive Parenting Program is a multi-level system of family intervention,which provides five levels of intervention of increasing strength. These interventions include a universal population-level media strategy targeting all parents, two levels of brief primary care consultations targeting mild  behaviour problems and two more intensive parent training and family intervention programs for children at risk for more severe behavioural 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 and format of the intervention to the requirements of individual families. Its multi-disciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatised access pointsthrough primary care services for families who are reluctant to participate in parenting skills programs. Theavailable empirical evidence supporting the efficacy of the program and its implications for research ondissemination are discussed.
 The quality of family life is fundamental to the wellbeing of children. Family relationships in general and the parent-childrelationship in particular have a pervasive influence on thepsychological, physical, social and economic wellbeing of children. Many significant mental health, social andeconomic problems are linked to disturbances in family functioning and the breakdown of family relationships(Chamberlain & Patterson, 1995; Patterson, 1982; Sanders &Duncan, 1995). Epidemiological studies indicate that family risk factors such as poor parenting, family conflict andmarriage breakdown strongly influence children’sdevelopment (e.g., Cummings & Davies, 1994; Dryfoos,1990; Robins, 1991). Specifically, a lack of a warm positiverelationship with parents; insecure attachment; harsh,inflexible, rigid or inconsistent discipline practices;inadequate supervision of and involvement with children;marital conflict and breakdown; and parentalpsychopathology (particularly maternal depression) increasethe risk that children will develop major behavioural andemotional problems, including substance abuse, antisocialbehaviour and juvenile crime (e.g., Coie, 1996; Loeber &Farrington, 1998). Although family relationships are important, parentsgenerally receive little preparation beyond the experience of having been parented themselves; with most learning on thejob, through trial and error (Risley, Clark, & Cataldo, 1976;Sanders et al., 2000). The demands of parenthood arefurther complicated when parents do not have access toextended family support networks (e.g., grandparents ortrusted family friends) for advice on child rearing, do nothave partners, or experience the stress of separation, divorceor repartnering (Lawton & Sanders, 1994; Sanders,Nicholson, & Floyd, 1997). This paper describes the conceptual and empiricalfoundations of the program’s comprehensive model of parenting and family support, which aims to better equipparents in their child rearing role. The program’s uniquefeatures, derivative programs and issues involved in theeffective dissemination of the system are discussed anddirections for future research are highlighted.
 The Triple P-Positive Parenting Program is a multi-level,preventively-oriented parenting and family support strategy developed by the authors and colleagues at The University of Queensland in Brisbane, Australia. The program aims toprevent severe behavioural, emotional and developmentalproblems in children by enhancing the knowledge, skills andconfidence of parents. It incorporates five levels of intervention on a tiered continuum of increasing strength(see Table 1) for parents of children and adolescents frombirth to age 16. Figure 1 depicts the differing levels of intensity and reach of the Triple P system. Level 1, auniversal parent information strategy, provides all interestedparents with access to useful information about parenting through a coordinated promotional campaign using printand electronic media as well as user-friendly parenting tipsheets and videotapes that demonstrate specific parenting strategies. This level of intervention aims to increasecommunity awareness of parenting resources and thereceptivity of parents to participating in programs, and tocreate a sense of optimism by depicting solutions tocommon behavioural and developmental concerns. Level 2is a brief, one to two-session primary health care
Parenting Research and Practice Monograph No. 1
 Matthew R. Sanders, Carol Markie-Dadds and Karen M.T. Turner
Table 1. The Triple P Model of Parenting and Family Support
Level of Intervention Target Population Intervention Methods Practitioners
Media-based parentinformation campaign
 Universal Triple P
 All parents interested ininformation aboutpromoting their child’sdevelopment Anticipatory well child careinvolving the provision of brief information on how to solvedevelopmental and minor behaviour problems. May involveself-directed resources, brief consultation, grouppresentations, mass mediastrategies, and telephonereferral servicesParent supportand/or healthpromotion (e.g.,parent aidevolunteers linked toagencies routinelyproviding Triple Pservices)
Brief selective intervention
Selected Triple PSelected Teen Triple P
 Parents with a specificconcern/s about their child’s behaviour or developmentProvision of specific advice for adiscrete child problembehaviour. May be self-directedor involve telephone or face-to-face clinician contact or groupsessionsParent supportduring routine well-child health care(e.g., child andcommunity health,education, alliedhealth and childcarestaff)
Narrow focus parent training
Primary Care Triple PPrimary Care Teen TripleP
Parents with a specificconcern/s about their child’s behaviour or development whorequire consultations or active skills trainingBrief therapy program (1 to 4clinic sessions) combiningadvice, rehearsal and self-evaluation to teach parents tomanage a discrete child problembehaviour. May involvetelephone or face-to-faceclinician contact or groupsessions As for Level 2
Broad focus parent training
Standard Triple PGroup Triple PGroup Teen Triple PSelf-Directed Triple P
Parents wantingintensive training inpositive parenting skills- typically parents of children with moresevere behaviour problemsIntensive program focussing onparent-child interaction and theapplication of parenting skills toa broad range of targetbehaviours. Includesgeneralisation enhancementstrategies. May be self-directedor involve telephone or face-to-face clinician contact or groupsessionsIntensive parentinginterventions (e.g.,mental health andwelfare staff andother allied healthprofessionals whoregularly consultwith parents aboutchild behaviour)
Stepping Stones Triple P
Families of preschoolchildren with disabilitieswho have or are at riskof developingbehavioural or emotional disorders A parallel 10-session individuallytailored program with a focus ondisabilities. Sessions typicallylast 60–90 minutes (with theexception of 3 home practicesessions which last 40 minutes) As above
Behavioural familyintervention modules
Enhanced Triple P
Parents of children withconcurrent childbehaviour problemsand family dysfunctionsuch as parentaldepression or stress or conflict betweenpartnersIntensive individually tailoredprogram with modules includinghome visits to enhanceparenting skills, moodmanagement strategies andstress coping skills, and partner support skills. May involvetelephone or face-to-faceclinician contact or groupsessionsIntensive familyintervention work(e.g., mental healthand welfare staff)
Pathways Triple P
Parents at risk of maltreating their children. Targets anger management problemsand other factorsassociated with abuseModules include attributionretraining and anger management As above
  Triple P-Positive Parenting Program: A Population Approach to the Promotion of Parenting Competence
Figure 1. The Triple P Model of Graded Reach and Intensity of Parenting and Family Support Services
intervention providing early anticipatory developmentalguidance to parents of children with mild behaviourdifficulties or developmental issues. Level 3, a four-sessionintervention, targets children with mild to moderatebehaviour difficulties and includes active skills training forparents. Level 4 is an intensive eight to ten-sessionindividual, group or self-directed parent training programfor children with more severe behavioural difficulties. Level5 is an enhanced behavioural family intervention programfor families where child behaviour problems persist or where parenting difficulties are complicated by othersources of family distress (e.g., marital conflict, parentaldepression or high levels of stress). The rationale for this multi-level strategy is that there arediffering levels of dysfunction and behavioural disturbancein children, and parents have different needs andpreferences regarding the type, intensity and mode of assistance they may require. This tiered approach is designedto maximise efficiency, contain costs, avoid waste and overservicing, and to ensure the program has wide reach in thecommunity. Also, the multi-disciplinary nature of theprogram involves the better utilisation of the existing professional workforce in the task of promoting competentparenting. The program targets five different developmentalperiods: infants, toddlers, preschoolers, primary schoolersand teenagers. Within each developmental period the reachof the intervention can vary from being very broad(targeting an entire population) or quite narrow (targeting only high-risk children). This flexibility enables practitionersto determine the scope of the intervention within their ownservice priorities and funding.
 Triple P is a form of behavioural family interventionbased on social learning principles (e.g., Patterson, 1982). This approach to the treatment and prevention of childhooddisorders has the strongest empirical support of any intervention with children, particularly those with conductproblems (see Kazdin, 1987; Sanders, 1996; Taylor &Biglan, 1998; Webster-Stratton & Hammond, 1997). TripleP aims to enhance family protective factors and to reducerisk factors associated with severe behavioural andemotional problems in children and adolescents. Specifically the program aims to: 1) enhance the knowledge, skills,confidence, self-sufficiency and resourcefulness of parents;2) promote nurturing, safe, engaging, non-violent and low conflict environments for children; and 3) promotechildren’s social, emotional, language, intellectual andbehavioural competencies through positive parenting practices. The program content draws on the following:1.
Social learning models of parent-child interaction thathighlight the reciprocal and bidirectional nature of parent-child interactions (e.g., Patterson, 1982). This modelidentifies learning mechanisms, which maintain coerciveand dysfunctional patterns of family interaction andpredict future antisocial behaviour in children (Patterson,Reid, & Dishion, 1992). As a consequence, the programspecifically teaches parents positive child managementskills as an alternative to coercive, inadequate orineffective parenting practices.2.
Research in child and family behaviour therapy andapplied behaviour analysis, which has developed many useful behaviour change strategies, particularly researchthat focuses on rearranging antecedents of problembehaviour through designing more positive engaging 

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