The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support

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Highlights

  • Reviewed 101 Triple P studies spanning 33 years of research

  • Seven outcome variables and 15 moderator variables were evaluated.

  • Significant effect sizes on child and parent outcomes at short term and long term

  • No single moderator effected all outcome variables.

  • The results support the use of Triple P as a blended system of parenting support.

Abstract

This systematic review and meta-analysis examined the effects of the multilevel Triple P-Positive Parenting Program system on a broad range of child, parent and family outcomes. Multiple search strategies identified 116 eligible studies conducted over a 33-year period, with 101 studies comprising 16,099 families analyzed quantitatively. Moderator analyses were conducted using structural equation modeling. Risk of bias within and across studies was assessed. Significant short-term effects were found for: children's social, emotional and behavioral outcomes (d = 0.473); parenting practices (d = 0.578); parenting satisfaction and efficacy (d = 0.519); parental adjustment (d = 0.340); parental relationship (d = 0.225) and child observational data (d = 0.501). Significant effects were found for all outcomes at long-term including parent observational data (d = 0.249). Moderator analyses found that study approach, study power, Triple P level, and severity of initial child problems produced significant effects in multiple moderator models when controlling for other significant moderators. Several putative moderators did not have significant effects after controlling for other significant moderators. The positive results for each level of the Triple P system provide empirical support for a blending of universal and targeted parenting interventions to promote child, parent and family wellbeing.

Section snippets

Impact on child, parent and family outcomes

The first aim was to examine the effects of Triple P on proximal targets of the intervention, namely child social, emotional and behavioral (SEB) outcomes, parenting practices, and parenting satisfaction and efficacy. In terms of the child SEB outcomes, we define each component of these as being: social — a child's ability to interact and form relationships with other children, adults, and parenting figures; emotional — a child's ability to appropriately express and manage emotions and

Moderator effects

The second aim was to explore the impact of the following groups of moderator variables on program outcomes: (a) modifiable components of the intervention, (b) the characteristics of the sample studied, (c) methodological aspects of the research, and (d) risk of bias moderators. It should be noted that the moderator variables were chosen based on knowledge of the availability of data on different possible moderators. There were several other variables that would be meaningful to investigate but

Protocol and registration

The protocol for this review was registered on PROSPERO before completion of searching and data entry and was allocated the registration number: CRD42012003402.

Eligibility criteria

To be included in the review, studies needed to meet the following eligibility criteria:

  • (a)

    The study reported outcomes from an evaluation of an intervention recognized by the authors of the paper (either within the paper or upon author contact) as a Triple P program, delivered according to either a manual or a precursor format. Note that no

Study selection

The searches yielded a total of 1677 papers including 1065 unique studies. After screening papers for relevance according to title and abstract, 384 papers remained (including review articles). After assessing for eligibility, 159 studies reported on outcomes from an evaluation of Triple P. Papers were then excluded if they were not available in English or German (n = 4), if they did not report sufficient data (n = 15), only reported data on a Triple P intervention combined with another

Discussion

The results from this systematic review and meta-analysis clearly show that Triple P, in both short-term and long-term, is an effective parenting intervention for improving social, emotional and behavioral outcomes in children, and that it also has many benefits for participating parents. Meta-analytic techniques were performed on 101 studies (including 62 RCTs) conducted over 33 years, and comprising over 16,000 families from many different cultures and ethnicities. Combining data from all

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