Doctorate in Educational and Child Psychology
Pamela Hamilton
Case Study 1: An Evidence-Based Practice Review Report
Theme: Interventions for children with Special Educational Needs
What is the effectiveness of the Triple P programme (Positive Parenting
Programme) on reducing or preventing child behavioural/conduct problems?
Summary
This systematic literature review evaluates the evidence base for the effectiveness of
the Family Behavioural Intervention called Triple P. Triple P was designed by Sanders and
colleagues (1999) in response to the reduced success of previous behavioural family
interventions (BFI) for families in which parenting challenges are but one of the many
obstacles in which they have to overcome (Sanders, Markie-Dadds & Bor, 2000).
Triple P claims to be one of the most effective evidence based parenting
programmes in the world (www.triplep.net/glo-en/home).Triple P is a multi-level family
support strategy which consists of five intervention levels designed for parents of children
from birth to sixteen years of age who are at risk of developing conduct problems.
This review aims to evaluate post 2010 research into the influence of Triple P on
child behavioural outcomes. Five papers were identified to address the review question.
Overall results found that Triple-P was effective in reducing/preventing child conduct
problems. Promising evidence was also found for the effectiveness of Triple P in Asian
countries and children with developmental disabilities.
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Introduction
What is Triple P?
Triple P’s authors have suggested that Triple P is one of the most effective evidence
based parenting programmes in the world (www.triplep.net/glo-en/home). Triple P is a
multi-level family support strategy which consists of five intervention levels designed for
parents of children from birth to sixteen years of age who are at risk of developing conduct
problems. Conduct problems can be considered to refer to a wide range of “acting out”
behaviours which ranges from minor oppositional behaviour i.e. temper tantrums to more
serious physical aggression and theft (Peacock & Holland, 2003).
Triple P was designed by Sanders and colleagues (1999) in response to the reduced
success of previous behavioural family interventions (BFI) for families in which parenting
challenges are but one of the many obstacles in which they have to overcome (Sanders,
Markie-Dadds & Bor, 2000). Through a multi-level and tiered approach which increases in
strength, families are provided with the level of support which meets their needs. Table 1
describes each level of support.
Table 1
Levels of Triple P (information obtained from the Triple P website)
Level
Description
Level 1
Also known as universal Triple P, this model is designed
to read a large volume of people through positive
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parenting information messages provided through the
media.
Level 2
Also known as the “light touch” intervention, this
model provides a brief one or two session consultation
for parents who are coping well but have slight
concerns about their child’s behaviour or development.
Level 2 can also be delivered through seminars. Parents
can attend any number of three 90-minute seminars
(Power of Positive Parenting; Raising Confident,
Competent Children; and Raising Resilient Children) or
any of the three seminars in the Teen Triple P Seminar
Series
(Raising
Competent
Responsible
Teenagers;
Teenagers;
and Getting
Raising
Teenagers
Connected).
Level 3
This is a four session consultation model for children
with mild to moderate behavioural problems. It is
mainly used in the primary care setting and take the
form of a face-to-face or telephone intervention with a
primary care worker. Tip sheets and positive parenting
booklets are used to reinforce strategies. Alternatively
it can take the form of two hour small discussion
groups targeting specific issues.
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Level 4
Pamela Hamilton
Also known as Standard Triple P, the intensity of the
Triple P programme greatly increases at this level.
Level 4 consists of 8-10 sessions and is typically for
parents with children who are displaying more severe
behavioural problems such as aggression. It can be
delivered through individual, group, self-help or online
course formats.
Level 5
This programme takes two formats. Enhanced Triple P
is for families facing parenting concerns in addition to
other obstacles, such as parental mood disturbance.
This model best reflects the diversity of parental
support offered by the programme due to it being
individually tailored to meet the needs of the family.
Alternatively, at this level Pathways Triple P is offered
to families where child maltreatment is a risk.
Pathways Triple P provides assistance with anger
management and coping strategies along with other
behavioural strategies at an enhanced level. Parents
must complete a level four programme before
accessing level 5.
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Basis in Psychological Theory
Behavioural principles drawn from social learning theory, cognitive and
developmental psychology strongly underlie the Triple P model. In addition, Triple P also
draws upon research into the risk factors mentioned above which can influence parenting.
Social learning theorist Bandura (1977) suggested that behaviour is learned via the
environment through observation. Children will observe the way in which others (models)
around them behave and copy such behaviour. Children are presented with many models in
their environment, such as friends and individuals from popular culture. However, their
primary caregiver, their parent(s), can be considered to be their most influential model.
Other Social learning theorists, such as Patterson (1982), have developed Bandura’s
thinking. Research into the reciprocal and bidirectional nature of parent and child
interaction has identified that parents may directly train their child to perform antisocial
behaviours. Parents may be non-contingent in the positive reinforcement of pro social
behaviours and their sanctions towards challenging behaviours. This results in many
challenging daily behaviours by the child being reinforced. The child then uses their
challenging behaviour to reduce aversive intrusions by family members and the behaviour
then becomes functional. This causes coercive behaviours for all parties to increase and
escalate, often resulting in the child learning to control the family by coercive means
(Patterson, DeBaryshe, & Ramsey, 1989)
As a result of this Triple P teaches parents positive child management skills as an
alternative to coercive and inadequate parenting. Triple P teaches parents that, as social
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learning theory suggests, a child’s behaviour will improve if it is appropriately reinforced.
Therefore, good behaviour will increase if it is rewarded and bad behaviour will decrease if
it is ignored or adequately sanctioned. In addition, Cognitive Behavioural Therapy (CBT) has
greatly influenced Triple P at level 5. CBT techniques such as mood monitoring and
challenging dysfunctional cognitions are frequently used at this level.
Sanders, Dadds and Turner (2003) note that social information processing models
has influenced the content of Triple P. This theory emphasises the role in which parental
attributions, beliefs and expectations influence parental self-efficacy, decision making and
behaviour intentions. Triple P aims to address this by facilitating the parent in reframing
their understanding of the child’s and their own behaviour.
Relevance to EP practice
Behavioural, social and emotional difficulties (BESD) have a significant impact on a
child’s learning outcome (Amstrong & Hallett, 2012) and life chances. BESD and learning
difficulties are not mutually exclusive. Students with BESD can have behaviour problems
which may frustrate their access to the curriculum. For example, a child with BESD who is
frequently excluded from school for aggressive behaviour will miss out on social and
academic learning experiences which will ultimately influence their academic attainment
and peer relationships.
Educational psychologists are frequently involved in BESD cases and BESD is a
substantial part of the EP’s remit. In 2010 the Association of Educational Psychologists and
Educational psychology (AEPEP) submitted a memorandum to the UK government which
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focused on the role, associated benefits, and additional resources that educational
psychologists can provide to schools in order to effectively manage challenging behaviour
and discipline (AEPEP, 2010).
However, whilst the report focused on school based interventions there is a strong
link between parenting and child behaviour. Negative parenting style characterised by harsh
and inconsistent discipline have been found to be associated with severe child antisocial
behaviour. In addition, lack of involvement and poor child monitoring strongly predicts
antisocial behaviour (Loeber & Stouthamer-Loeber, 1986). Reid, Webster-Stratton & Baydar
(2004) also note that permissive and inconsistent parenting, along with the use of more
violent and critical discipline is more likely to result in a child with anti-social behaviour.
The Department for Education have suggested that appropriate parenting
programmes which reduce coercive parenting practices, improve positive parenting, and
reduce child antisocial behaviour would be beneficial in tackling the above (Scott, Doolan,
Beckett, Harry, Cartwright & the HCA team). A range of behavioural family intervention
programmes have been identified by the DfE, which includes standard Triple P parenting
programme (www.education.gov.uk/commissioning-toolkit/Programme/Detail/36).
Whilst the above research has used the terms BESD and anti-social behaviour they
can both be identified as characteristic of conduct problems. However, whilst the Standard
Triple P programme has been suggested, an Educational Psychologist has to consider the
financial implications and cost effectiveness of the family behavioural intervention in this
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time of austerity. Therefore, providing a range of less costly Triple P services that have a
reliable evidence base would be advantageous. This, suggestion is particularly supported by
the fact that the whole Triple P programme has been found to produce predictable
decreases in child behaviour problems (Graff, Speetjens, Smit, de Wolff & Tavecchio, 2008)
at both level 3 and 4 for parents from various populations and family types.
Review Question (101 words)
Research into the effectiveness of Behavioural Family Interventions for pupils who
have or at risk of developing conduct problems/disorder have looked at child outcomes.
However, the most recent meta-analyses of Tripe P at all levels was in 2008 (Nowak &
Heinrichs, 2008). Five years have passed since then and additional studies info the
effectiveness of Triple P has been released. The aim of this study is to evaluate post 2010
research into the influence of Triple P on child behavioural outcomes. The review question is
“What is the effectiveness of the Triple P programme (Positive Parenting Programme) on
preventing/reducing child conduct problems?”
1. Critical Review of the Evidence Base
1.1 Literature search 239
A systematic search of the electronic databases PsychInfo, Educational Resource
Information Centre (ERIC) and Medline was undertaken on the 18th December 2013. The
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following relevant search terms and directions were used to obtain studies relevant to the
review.
PsychINFO
Key word searches were carried out using the following words:
1. Triple P OR Triple-p (Title)
ERIC
Key word searches were carried out using the following words:
1. Triple P OR Triple-p (Title)
Medline
Key word searches were carried out using the following words:
1. Triple P OR Triple-p (Title)
Using the above mentioned databases’ search engine, the initial search was limited
by the inclusion criteria identified in 1a, b, c and d (Appendix A), and combined. Once the
duplicates were removed, the titles and abstracts of 26 studies were screened for eligibility.
A full article search was undertaken of the remaining studies which gave insufficient
information within their titles or abstracts to be able to decide upon the desirability of the
study for the review. The inclusion criteria were applied to the 10 studies which left five that
were suitable for the review question. Figure 1 depicts the entire process for identifying
studies from the initial searches to screening and selecting studies for the review. The
inclusion and exclusion criteria are described in Appendix A, and the excluded studies,
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following the screening of the full article, plus rationale for exclusion are listed in Appendix
B. Table 2 identifies the names of the studies that were selected based on the result of
screening process.
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Figure 1
Study Identification Process
Articles identified from
the electronic
databases (PsychINFO,
ERIC and Medline)
Limits applied and
duplicates removed
(N=124)
Excluded bases on
criteria 1a, b, c and d
Titles and abstracts
screened (N=26)
Full text and articles
screened (N=10)
Studies included in the
review (N=5)
Figure 1. Flowchart if
11
(N=98)
Excluded bases on
criteria 1a, 1e, 1f, 3a,
3c, 4b, 4c, (N=14)
Excluded bases on
criteria 1a, 2d, 3c,4b,4c
(N=5)
Pamela Hamilton
Doctorate in Educational and Child Psychology
Pamela Hamilton
Table 2
List of Studies Eligible for the Review
1. 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.
2. Heinrichs, N., Kliem, S., & Hahlweg, K. (2013). Four-year follow-up of a randomized
controlled trial of triple p group for parent and child outcomes. Prevention Science,
1-13.
3. Leung, C., Fan, A. & Sanders, M.R. (2013). The effectiveness of a group triple p with
chinese parents who have a child with developmental disability: a randomized
controlled trial. Research in Developmental Disabilities, 34, 976-984.
4. Sanders, M.R., Baker, S. & Turner, K.M.T. (2012). A randomized controlled trial
evaluating the efficacy of triple p online with parents of children with early onset
conduct problems. Behaviour Research and Therapy, 50, 675-684.
5. Sofronoff, K., Jahnel, D., & Sanders, M. (2011). Stepping Stones Triple P seminars for
parents of a child with a disability: a randomized controlled trial. Research in
Developmental Disabilities, 32(6), 2253-2262.
1.2 Quality and Relevance Appraisal
The studies were initially summarised to identify main information (see appendix C). The
studies were then coded based on a coding protocol adapted from the Task Force on
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Evidence-Based Intervention in School Psychology which was produced by Kratochwill
(2003). This was followed by identifying the weight of evidence of each study by following
the weight of evidence protocol identified by Harden and Gough (2012). The weight of
evidence framework identifies 3 dimensions for weighting studies. These are:
a) Methodological quality: The quality of execution of the study in relation to the
quality standards for the study type.
b) Methodological relevance: The appropriateness of research design for addressing
the review question.
c) Topic relevance: The appropriateness of focus of study to review question.
The weighting of each study is identified in Table 3 and the detailing on how each
judgment was formed and scores awarded can be found in Appendix D under the relevant
headings.
Table 3
Weighting of Studies
Study
13
A
B
C
D
Doctorate in Educational and Child Psychology
Pamela Hamilton
Methodological
Methodological
Topic
Overall
Quality
Relevance
Relevance
Weight of
Evidence
Fujiwara, Kato &
1.5
2
2
5.5
Sanders (2011)
Low
Low
Low
Low
Heinrichs, Kliem &
3.5
4
Hahlweg (2013)
High
High
Laung, Fan &
3
Sanders (2013)
3
10.5
Medium
High
2
2
7
Medium
Low
Low
Low
Sanders, Baker &
4.5
4
4
12.5
Turner (2012)
High
High
High
High
Sofronoff, Jahnel &
1.5
Sanders
Low
1.3 Critique and Appraisal of Studies
1.3.1 Sample
14
3
Medium
3
7.5
Medium
Low
Doctorate in Educational and Child Psychology
Pamela Hamilton
In determining an appropriate sample size it was decided that the suggestion
articulated in a Triple P meta-analysis by Graff et al. (2008) that a sample size of 10-50 is too
small would be taken on board. Therefore, a small sample size below 50 would be
considered small, 51-100 medium and 101+ large. Sample size was calculated from the point
of allocation of families to the control or intervention group.
de Graff et al. (2008) in their results identified that the overall mean effect size for improved
child behaviour which was observed by parents was d = 0.88. However, according to Cohen
(1988) an anticipated effect size of .88, with a statistical power of .8 and probability level of
.05 would require a minimum total sample size of 34 participants (one-tailed) and 44
participants (two-tailed). For the purpose of this review the sample size suggestions put
forward by Graff et al. will be taken on board as their suggestions specifically relate to Triple
P. However, when addressing issues relating to small sample size the comments of Cohen
will be taken on board if necessary.
Three out of the five studies included in this study had a large sample size of over
100 participants. However, there were two studies that did not have an adequate
randomization of participants. Fujiwara et al. (2011) had 91 participants in the intervention
group and 24 participants in the control group and Heinrichs et al. (2013) had 186 families in
the intervention group and 84 families in the control group. However, this was a result of
only 23% of parents declining to participate in the intervention and not the anticipated 50%
following stratified randomisation to assign treatment to schools. Sofronoff et al. (2011) also
comment on their small sample size limiting the power of effects. Heinrichs et al. (2013)
used hierarchical linear modelling as it models the covariance structure of the data and
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Fujiwara et al used a multivariate analysis of variance (MANOVA) to adjust for the covariates
that differed significantly. In addition, Sofronoff et al. (2011) did not state if there were any
significant differences in the demographic characteristics between the intervention and wait
list control group. Significant differences between the samples were reported in the
Heinrichs et al. study (2013). Heinrichs et al. reported a higher percentage of single mother
participants (34 vs 15.6) in the intervention group. As Fujiwara et al. (2011) implemented a
quasi-experimental design their groups were also not equally matched.
All studies had a noticeable difference in the number of fathers compared to
mothers participating in the intervention. This is something that has been consistently
picked up in previous Triple P meta-analysis. However, the Heinrichs et al. (2013). study
does go some way to remedy this due to the large number of two parent families within its
study (N=219). Interestingly, the Heinrichs et al. and Sanders et al. (2012) studies had a
small number of families from low socio-economic backgrounds. This finding assists in
evaluating the effectiveness of Triple P for families who have a higher socio economic status
as many Triple P studies using the group format have successfully targeted low income
families (Nowak & Heinrichs, 2008). In addition, as reported by pervious meta-analysis
overall there was a much higher proportion of parents who had identified problem
behaviour relating to a son and not a daughter.
The recruitment process took different forms ranging from promotion posters and
application forms distributed to parents of children receiving support for neurological
impairment (Leung et al., 2013) to the stratified randomisation to assign treatment to
schools. The Sofronoff et al. (2011) study stated that participants indicated an interest, they
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did not say how the participants were contacted. It was only the Sanders et al. (2012) study
that placed an academic eligibility criteria upon parents in order to be eligible for the study.
This study required parents to read English to a year 5 level. In addition, parents were also
required to have broadband and internet connection, as it was an online intervention.
What should also be noted is that whilst some studies included in this review have
exclusion criteria relating to child disability, enrolled siblings and the accessing of other
interventions (Heinrichs et al., 2013; Sanders et al.), other studies do not have such criteria
or are actively researching the disability group. In addition, none of the studies were
undertaken in the UK. Nowak and Heinrichs (2008) have identified that the average attrition
rate across all Triple P interventions is 19.5%. The only study that had an attrition rate above
this was the Sofronoff et al. (2011) study which had an overall attrition rate of 30%. Attrition
was calculated as the amount of participants who did not complete the post-intervention
questionnaires following allocation to intervention or control group. In addition, the
Heinrichs et al. (2013). study did not state the amount of participants who completed the
post intervention questionnaire. However, the study did state the amount of participants
who completed the 4-year follow-up questionnaire. Overall, this study had an attrition rate
of 10% even though it had a substantial follow-up period.
1.3.2 Design
Four studies were randomised control (RCT) group design. However, the Heinrichs et
al. (2013) study was only randomised up to the point that the preschools were selected.
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Furthermore, the numbers of schools in the treatment (N=11) and control (N=6) differed
considerably. Fujiwara et al. (2011) used a quasi-experimental design.
Four studies collected baseline data of child behaviour using either the Strengths and
Difficulties Questionnaire (SDQ), Eyberg Child Behavior Inventory (ECBI) or Child Behaviour
Checklist (CBLC). This affected the overall quality of methodology in the study and was
reflected with low ratings on the weight of evidence table due to multi-method data not
being obtained. However, Heinrichs et al. (2013) did provide multi-source information by
providing separate questionnaire data obtained from both parents. This may have been due
to the large sample of two-parent families participating in the study. Sanders et al. (2012)
used three behavioural indicators. These being the SDQ, ECHI and a 40 minute observation
of the parent and child. This was coded by research assistants using the Family Observation
Schedule (FOS) (Sanders, 2000). However, the power of the observational data was low due
to the low observation sample size.
Fujiwara et al. (2011) reported on the reliability of the SDQ for a Japanese
population, Heainrichs et al. (2013) on the internal consistency of the German version of the
CBCL and Leung et al. (2013) on the reliability of the Chinese version of the ECBI. Sofronoff
et al. (2011) reported on the internal reliability of the ECBI. Sanders et al. (2012)
commented on the test-retest reliability and internal consistency of the ECBI and SDQ and
the inter-rater reliability of the observations. The studies also differed on their level of
follow up for the control group with one studying following up at three months, three
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studies following up at six months and the Heinrichs et al. study following up at set times in
a four year period.
1.3.3 Intervention
Only the Leung et al. 2013 and Heinrichs et al. 2013 studies stated that the Triple P
intervention groups were delivered by accredited providers. Furthermore, only the Leung et
al. study stated that protocol adherence was discussed and that trainers adhered to the
Triple P manual and resource materials. All trainer led Triple P interventions had a specific
end date. However, these studies do not make clear if Triple P completion required all the
sessions to be attended. Sanders et al. in their Triple P online study highlights that there was
a considerable difference in the log on and completion times of the participants. However,
the paper does state that after the completion of the study (i.e. after 9 months) participants
in the internet-as-usual group were allowed access to the intervention. This suggests that
some participants may not have completed the intervention whilst completing evaluation
data.
1.3.4 Weight of Evidence Summary
The Fujiwara et al. (2011) study scored low for methodological quality. The study
gained points for providing enough information for the sample size to be calculated, having
more than 51 participants and establishing group equivalence. However, the study did not
have a RCT design, use multi source or multi method data, use measures for specific target
audience, conduct follow up analysis on control and intervention group. In addition, the
study did not state attrition information so points could not be gained.
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The Sanders et al. (2012) study scored high for methodological quality. They were
able to demonstrate all of the methodological quality criteria (see WOE A in appendix D).
The Heinrichs et al. (2013) study also scored high. However, unlike Sanders et al. they were
unable to demonstrate multi method and multi-source data collection. The Leung et al.
(2013) study scored medium for methodological quality. They were able to demonstrate the
use of a RCT design, measures specific for target audience, provision of enough information
for effect size to be calculated, more than 51 participants, low attrition and group
equivalence. However, they did not demonstrate the addition criteria to score high. The
Sofronoff et al. (2011) study scored low for methodological quality. The study demonstrated
a RCT design, more than 51 participants, follow-up on intervention and control group and
group equivalence. However, they failed to demonstrate the other criteria.
The Fujiwara et al. (2011) and Leung et al. (2013) studies scored low for
methodological relevance. Whilst they were able to demonstrate the obtaining of pre and
post-test measure for all groups involved they were unable to meet the criteria to obtain
higher scores (See WOE B in Appendix D). The Sofronoff et al. (2011) study scored medium
for methodological relevance. The study was able to demonstrate the use of a control group
and pre, post and follow up measures for the intervention and control group. However, the
study did not meet the criteria to obtain a higher score (See WOE B in Appendix D)
The Heinrichs et al. (2013) and Sanders et al. (2012) studies both scored high for
methodological relevance. Both studies were able to demonstrate the random assignment
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of participants to the control or intervention group. They studies also adjusted for
confounding variables and used pre, post and follow-up measures for all groups involved
with the means and standard deviations reported. The Fujiwara et al. (2011) study scored
low for topic relevance. The study demonstrated the use of Triple P with participants aged
between 2-11 years and the collection of pre and post measures. The study was also able to
demonstrate that participants were identified as having elevated levels of child behavioural
problems through the analysis of established child behaviour measure(s). However, it did
not meet the criteria to obtain a higher score.
The Sofronoff et al. (2011) and Heinrichs et al. (2013) studies scored medium for
methodological relevance. The studies were able to demonstrate the use of Triple P with
participants aged between 2-11 years who have been identified as having elevated levels of
child behavioural problems through the analysis of established child behaviour measure(s)
or parents requesting to undertake Triple P training. In addition, the study also used pre,
post and follow up measures (3 months or more). However, the studies did not meet the
criteria to obtain a higher score.
The Sanders et al. (2012) study was the only study to score high for topic relevance.
The study was able to demonstrate the use of Triple P with participants aged between 2-11
years who were identified as having elevated levels of child behavioural problems through
the analysis of multiple and established sources of information (e.g. ECBI and observations)
or parents requesting to undertake Triple P training. The study also used pre, post and
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follow up measures (6 months or more). Finally, the study reported the means and standard
deviations for the child behaviour subscales of the child behaviour.
See the final paragraph of Appendix D (WOE D) for how the overall WOE was
calculated.
1.4 Outcomes
1.4.1 Child behaviours
In a meta-analysis of Triple P Nowack and Heinrichs (2008) identified the overall
effect size of Triple P for child problem behaviour to range between 0.35 and 0.48 for
between-groups. Similarly de Graaf et al. (2008) found a mean effect size post intervention
of .42 (studies used Cohen’s d). Therefore, for the purpose of this study effect sizes below
0.35 will be considered to be low, effect sizes of .36 to .47 as medium and effect sizes above
.48 will be considered to be high. However, this review recognises that this classification
does not correlate with more established effect sizes classifications. Cohen (1988) identifies
0.2 as a small effect, an effect size of 0.5 as a medium effect and an effect size of 0.8 as a
large effect. However, the suggested classifications will be used as it specifically relates to
Triple P and the effect size findings of previous meta-analyses.
The mean effect size of interventions that provided post and follow up data will be
listed in the overall weight of evidence column. Interventions that did not provide follow up
information will have their post intervention effect size repeated in the overall weight of
evidence column.
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The Heinrich et al. (2013) study used the Child Behaviour Checklist (CBLC). The CBCL
focuses on the child’s internalising (emotional) and externalising (conduct) behaviours. The
data provided by the study does not provide individual data for the emotional and conduct
behaviour. Whilst this review had focused on data which specifically focuses on the conduct
of a child the Heinrichs et al. study was still included due to it having a four year follow up
period, data from both partnership mothers (PM) and fathers and single mothers (SM).
Partnership fathers in this study did not report a significant change in behaviour at any time.
Therefore, their data is not included in the table.
Effectiveness of Triple P on reducing child behavioural/conduct problems
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Table 4
Effectiveness of Triple P intervention
Study
Outcome
Effect size –
Effect size
Overall
measure
Cohen’s d
Cohen’s d
Weight of
(Post
(Time and
Evidence
intervention)
Follow up)
Studies using the Strengths and Difficulties Questionnaire (SDQ)
Fujiwara, Kato &
SDQ- conduct
.11
Sanders (2011)
Sanders, Baker &
Not
Low
undertaken
SDQ- conduct
-.58
Turner (2012)
-.42
High
(6 months)
Overall effect size
- .24
-.42
Studies using the Eyberg Child Behavior Inventory (ECBI)
Sanders, Baker &
ECBI-problem
-.70
-.60
High
Turner (2012)
ECBI-intensity
-.89
-.74
High
(6 months)
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ECBI-problem
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-.21
Sanders(2013)
Not undertaken
Low
for control
ECBI-intensity
-.29
Not undertaken
Low
for control
(6 months)
Sofronoff, Jahnel &
ECBI-problem
.36
Sanders (2011)
Not undertaken
Medium
for control
ECBI-intensity
.16a
Not undertaken Cannot
for control
calculate
(3 months)
Overall effect size
.41
.67
Studies using observation
Sanders, Baker
Observed child IDb
.14
Turner (2012)
disruptive
(6 months)
behaviour
Studies using the Child Behaviour Checklist (CBLC)
Heinrichs, Kliem &
CBCL-PM
.14
.16
Hahlweg (2013)
CBCL-SM
.37
.52
(1 year)
25
Low
Doctorate in Educational and Child Psychology
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CBCL-PM
.06
CBLC-SM
.45
(2 years)
CBCL-PM
.12
CBLC-SM
.19
(3 years)
CBCL-PM
-.01 – CBLC
Scores of
intervention group
slightly above control
CBLC-SM
Overall effect size
.41
.23
.24
Overall effect size PM
.08
Overall effect size SM
.39
a
Effect size found to be not significant.
b
Study does not provide p-value and only states that it is not significant.
26
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Strengths and Difficulties Questionnaire
The two studies that measured child behaviour using the SDQ reported vastly
different effect sizes which differed by .47 post intervention. Unfortunately, the Fujiwara et
al. (2011) study did not undertake follow up evaluations. Therefore, follow-up evaluation
data could only be obtained from the Sanders et al. (2012) study. This data highlights that
the maintenance effect of the intervention over a six month period dropped from -.58 to .42. However, the follow up effect size does fall within the Triple P effect size range
previously identified by Nowak and Heinrichs (2008). Therefore, the follow up effect size
using the SDQ will be considered medium.
Eyberg Child Behavior Inventory (ECBI)
Three studies measured child behavior using the ECBI which reported vastly different
effect sizes. These ranged from Sofronoff et al. (2011) reporting no significant effect for ECBI
intensity to Sanders et al. (2012) reporting an ECBI intensity of -.89. The difference in effect
size may be due to the Leung et al. (2013) and Sofronoff et al. studies focusing on the
effectiveness of Triple P with children with developmental disabilities.
Children with developmental disabilities and their parents may have different needs,
characteristic and backgrounds which Triple P cannot individually cater for. In addition,
children with developmental disabilities may present more complex behaviours which are
more resilient to change (Roberts, Mazzucchelli, Studman, & Sanders, 2006) and continuous
parental supervision of the child’s behaviour to prevent harm to self or others is required
(Plant & Sanders, 2007)
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Doctorate in Educational and Child Psychology
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The problem and intensity subscales of all of the studies were merged together to
identify an overall effect size post intervention and at follow up. The mean effect size post
intervention for the ECBI subscales was .41 which is a medium effect size. The mean effect
size at follow up was large at .67. However, this figure should be treated with caution as it is
only representative of the Sanders et al. (2012) study as follow up was not conducted by the
other studies.
Child behavior observation
Sanders et al. (2012) was the only study that used child behavior observation. They
reported a small effect size of .14. However, the effect size may have been significantly
reduced due to the small number of participants which was the result of a technical issue.
Effectiveness of Triple P on preventing child behavioural/conduct problems
Child Behaviour Checklist
There was a considerable difference between the post intervention effect size of
PM’s (.14) and SM’s (.37). This trend was continued throughout the four year follow up
(apart from in the third year). The overall follow-up effect size for PM’s was .08 and for SM’s
.39. The results for SM’s shows strong intervention maintenance effects for the
effectiveness of Triple P in the prevention of child conduct problems. The strong
intervention effects for SM’s may have been caused by SM’s reporting higher levels of
28
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dysfunctional parenting which was significantly reduced during the course of the
intervention and follow up.
Overall behavioral evaluations
Triple P has a strong maintenance effect of up to four years. In combining the overall
individual effect sizes of the SDQ, ECBI and CBCL the overall combined effect size for these
behavioural measures is .49. which is a large effect size.
2. Conclusions
This systematic review aimed to evaluate the effectiveness of the Triple P on
reducing or preventing child behavioural/conduct problems. The studies overall weight of
evidence provided mixed results, with only the Heinrichs et al. (2013) and Sanders et al.
(2012) study receiving a high rating (three of the studies included in this review are coauthored by Sanders who is the founder of Triple P). The high rating was primarily because
of the low methodological quality rating given to the other studies due to multi-source and
multi-method data not being obtained.
Nearly all studies used questionnaires are their only evaluative tool. These are
subjective self-report measures and as noted by Webster-Stratton and Lindsay (1999) solely
relying on parent reports alone can misrepresent findings as parents can be biased by
personal factors. The finding of this study support previous research which suggests that
Triple P is effective in reducing or preventing child behavioural/conduct problems. The
29
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Pamela Hamilton
Triple P effect sizes range from .11 to .89. However, the Sanders et al. study, which was the
most rigorous, reported an effect sizes of over .6 post intervention and at follow up.
Triple P is considerably more effective for children who are not disabled. This may
be due to the suggestions articulated earlier that children with developmental disabilities
and their parents may have different needs which Triple P cannot cater for. In addition,
children with developmental disabilities may present more complex behaviors which are
more resilient to change. The effectiveness of Triple P in non-western societies also has
room for improvement. The studies in this review conducted in Japan and Hong Kong have
considerably low effect sizes. This may be due to the difference in parenting styles between
western and Asian culture. Whilst the Heinrichs et. al. (2013) study also report low effect
sizes this, as Nowak and Heinrichs (2008) point out, can be attributed to fathers showing
considerably less improvement in child behaviour compared to mothers. However, until
many more fathers start to participate in studies of the effectiveness of Triple P this finding
should be treated tentatively. In addition, TPOL has been found to produce sufficient effect
sizes whilst costing the least money.
Whilst the overall weight of evidence for the Leung at al. (2013) and Fujiwara et al.
(2011) studies are low they do highlight that Triple P can work in countries where English is
not the first language. However, these studies did not conduct follow-up evaluations with
the control group. In addition, none of the studies undertaken in this review were in the UK.
This raises questions as to Triple P’s effectiveness for a UK population, especially in highly
diverse communities.
30
Doctorate in Educational and Child Psychology
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As discussed earlier the interventions for children with developmental disabilities
scored considerably lower effect sizes. Sofronoff et al. (2011) suggests that this may be that
parents have re-evaluated the behaviour. Therefore the behaviour may still be persisting
but parents no longer perceive it as problematic. If this is the case multi-source evaluation
data would be highly valuable in proving this hypothesis. Triple P is an effective programme
for reducing and preventing child behavioural and conduct problems. Hopefully future
research will help to iron out some of this issues brought up in this review.
4.1Recommendations
In order to improve the weight of evidence of studies into Triple P multi-source and
multi method data needs to be obtained when undertaking research. In addition, further
research should obtain follow up data of one year minimum from both intervention and
control group. There was much inconsistency in the follow-up of the studies included in this
paper. Rigorous and lengthy follow-ups with low attrition rates would enable judgements on
the long term maintenance effect of Triple P to be made.
It would be financially advantageous to look into the effectiveness of online Triple P
with the UK population. Online Triple P (which is a level 4 intervention) would enable more
families to access the programme whilst requiring less money from the government. Due to
this reason I would recommend the use of the intervention in this way.
31
Doctorate in Educational and Child Psychology
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References
AEPEP. (2010). Memorandum submitted by The Association of Education Psychologists.
Armstrong, D. & Hallett, F. (2012). Private knowledge, public face: conceptions of children
with SEBD by teachers in the UK – a case study. Educational and Child Psychology, 29, 77-87.
Bandura, A. Ross, D., & Ross, S. A. (1961). Transmission of aggression through the imitation
of aggressive models. Journal of Abnormal and Social Psychology, 63, 575-582.
Bandura, A. (1977). Social learning theory. New Jersey: Prentice Hall.
Cohen J. (1988). Statistical power analysis for the behavioral sciences (2nd ed). New Jersey:
Erlbaum.
de Graaf, I., Speetjens, P., Smit, F., de Wolff, M., & Tavecchio, L. (2008). Effectiveness of the
triple p positive parenting program on behavioral problems in children a meta-analysis.
Behavior Modification, 32(5), 714-735.
Scott, S., Doolan, M., Beckett, C., Harry, S., Cartwright, S. and the HCA team. (2010). How is
parenting style related to child antisocial behaviour? Preliminary findings from the Helping
Children Achieve Study. Department for Education: Research Report DFE-RR185a.
32
Doctorate in Educational and Child Psychology
Pamela Hamilton
Ferrari, A.J., Whittingham, K., Boyd, R. Sanders, M & Colditz, P. (2011). Prem baby triple p a
new parenting intervention for parents of infants born very preterm: Acceptability and
barriers. Infant Behavior & Development, 34(4), 602-609.
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.
Harden, A., & Gough, D. (2012). Quality and relevance appraisal. IOE.
Heinrichs, N., Kliem, S., & Hahlweg, K. (2013). Four-year follow-up of a randomized
controlled trial of triple p group for parent and child outcomes. Prevention Science, 1-13.
Hodgetts, S., Savage, A. & McConnell, D. (2013). Experience and outcomes of stepping
stones triple P for families of children with autism. Research in Developmental Disabilities,
34 (9), 2572–2585.
Kratochwill, T.R. (2003). Task force on evidence-based interventions in school psychology.
American Psychology Association.
Leung, C., Fan, A. & Sanders, M.R. (2013). The effectiveness of a group triple p with chinese
parents who have a child with developmental disability: a randomized controlled trial.
Research in Developmental Disabilities, 34, 976-984.
33
Doctorate in Educational and Child Psychology
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Loeber, R., & Stouthamer-Loeber, M. (1986). Family factors as correlates and predictors of
juvenile conduct problems and delinquency. Crime & Justice, 7, 29.
Nowak, C., & Heinrichs, N. (2008). A comprehensive meta-analysis of Triple P-Positive
Parenting Program using hierarchical linear modeling: Effectiveness and moderating
variables. Clinical child and family psychology review, 11(3), 114-144.
Patterson, G. R. (1982). Coercive family process. Oregon: Castalia Publishing Company.
Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective on
antisocial behavior. American psychologist, 44(2), 329.
Peacock, M.L. & Gimple, G.A. (2003). Behavioural problems of young children. New York:
Guilford Press.
Petra, M. & Kohl, P. (2010). Pathways triple p and the child welfare system: A promising fit.
Children and youth services review, 34(2), 611-618.
Plant, K. M., & Sanders, M. R. (2007). Predictors of care‐giver stress in families of preschool‐
aged children with developmental disabilities. Journal of Intellectual Disability Research,
51(2), 109-124.
34
Doctorate in Educational and Child Psychology
Pamela Hamilton
Reid, M. J., Webster-Stratton, C., & Baydar, N. (2004). Halting the development of conduct
problems in Head Start children: The effects of parent training. Journal of Clinical Child and
Adolescent Psychology, 33(2), 279-291.
Roberts, C., Mazzucchelli, T., Studman, L., & Sanders, M. R. (2006). Behavioral family
intervention for children with developmental disabilities and behavioral problems. Journal
of Clinical Child and Adolescent Psychology, 35(2), 180-193.
Sanders, M.R., Baker, S. & Turner, K.M.T. (2012). A randomized controlled trial evaluating
the efficacy of triple p online with parents of children with early onset conduct problems.
Behaviour Research and Therapy, 50, 675-684.
Sanders, M.R., Stallman, H. & McHale, M. (2011) Workplace triple p: A controlled evaluation
of a parenting intervention for working parents. Journal of Family Psychology, 25(4), 581590.
Sanders, M. R., Markie-Dadds, C., & Turner, K. M. (2003). Theoretical, scientific and clinical
foundations of the triple p-positive parenting program: A population approach to the
promotion of parenting competence (Vol. 1). Queensland: Parenting and Family Support
Centre, The University of Queensland.
Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The triple P-positive
parenting program: a comparison of enhanced, standard, and self-directed behavioral family
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intervention for parents of children with early onset conduct problems. Journal of
Consulting and Clinical Psychology, 68(4), 624.
Sanders, M.R. (2000). Family observation schedule, QLD, Australia: Parenting and family
support centre, The University of Queensland.
Sanders, M. R. (1999). Triple p-positive parenting program: towards an empirically validated
multilevel parenting and family support strategy for the prevention of behavior and
emotional problems in children. Clinical Child and Family Psychology Review, 2(2), 71-90.
Sofronoff, K., Jahnel, D., & Sanders, M. (2011). Stepping Stones Triple P seminars for parents
of a child with a disability: a randomized controlled trial. Research in Developmental
Disabilities, 32(6), 2253-2262.
Spijkers, W., Jansen, D.E.M.C, de Meer, G. & Reijneveld, S.A. (2010) Effectiveness of a
parenting programme in a public health setting: a randomised controlled trial of the positive
parenting programme (Triple P) level 3 versus care as usual provided by the preventive child
healthcare (PCH). BMC Public Health, 10(1), 131-136.
Webster-Stratton, C., & Hammond, M. (1990). Predictors of treatment outcome in parent
training for families with conduct problem children. Behavior Therapy, 21(3), 319-337.
The Triple P website provides information of the breadth of the Triple P programme
(http://www.triplep.net/glo-en/the-triple-p-system-at-work/).
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Appendix A. Inclusion and Exclusion Criteria
Inclusion Criteria
Exclusion Criteria
1. Publication
a) The study only examines the effects
a) The study does not only examine the
of Triple P, as a parenting programme
effects of Triple P, as an parenting
for children with conduct problems,
programme for children with conduct
who are at risk of developing conduct
problems or who are at risk of
problems or parents who believe
developing conduct problems.
their child would benefit from the
Partial Triple P or combined or non
programme. Therefore, the sole
Triple P intervention effect sizes will
effectiveness of Triple P on conduct
not demonstrate the effectiveness of
problems can be ascertained.
the Triple P programme on reducing
conduct problems.
b) The article was published in a peer
reviewed journal, which would have
peer reviewed journal and would not
been evaluated and critiqued by
have been evaluated and critiqued by
researchers within the same field to
researchers within the same field to
meet quality standards
meet quality standards
c) The article was written in the English
language, as translation would not be
37
b) The article was not published in a
c) The article was not written in English,
as resources for translation were not
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required
d) The article was published between
Pamela Hamilton
readily available
d) The article was published before
2010 and 2013, and had therefore
2010 as the articles may have been
not been previously reviewed.
reviewed in the previous meta
analyses.
2. Participants
a) The participants must be between 2-
a) The participants are not within the 2-
10 years of age in order to look at the
10 years age range and would
relationships between Triple P and
therefore include adolescent onset
childhood onset conduct problems.
conduct problems.
b) Participants were not specifically
targeted because they had been
b) Participants were specifically
premature babies. This enables the
targeted because they had been
findings to be generalised and not
premature babies.
focus on a specific population.
3. Intervention
a) The intervention targets both
38
a) The intervention targets employed or
employed and unemployed parents.
unemployed parents. Such studies
This enabled the results to be
findings would not be generalisable
generalised to a wider social
over a wider social demographic.
Doctorate in Educational and Child Psychology
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demographic.
b) The intervention does specifically
b) The intervention does not specifically
target a specific event or time of day.
target a specific event or time of day.
Therefore, the effectiveness of triple
The effectiveness of Triple P
P throughout the day will not be
throughout the day will provide a
ascertained.
holistic view of the effectiveness of
the intervention.
c) The intervention did not have over
c) The intervention had over 60
children. Previous meta-analysis have
60 children and would therefore be
seen as a low sample size.
highlighted low sample sizes
influencing effectiveness analysis.
Analysing the effectiveness of studies
with larger sample sizes will provide
more robust evidence.
4. Outcomes
a) The study is a group experimental
design and therefore allows for the
experimental design and intervention
effect of the intervention to be
effects cannot be isolated.
isolated.
39
a) The study is not a group
Doctorate in Educational and Child Psychology
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b) Effectiveness of Triple P was not
b) Effectiveness of Triple P was assessed
assessed using a questionnaire for
by using a questionnaire for parents
parents to evaluate their child’s
to evaluate their child’s behaviour at
behaviour.
least.
c) The study does not provide sufficient
c) Sufficient empirical data was
40
empirical data for the calculation of
reported for the calculation of the
the standard effect size to be
standard effect size post intervention
calculated post intervention.
Doctorate in Educational and Child Psychology
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Appendix B. List of Excluded Studies
Excluded Study
Reason for Exclusion
1. Ferrari, A.J., Whittingham, K., Boyd, R. Sanders, M & Colditz, P. (2011). Prem baby triple P a new
parenting intervention for parents of infants born very preterm: Acceptability and barriers. Infant
Behavior & Development, 34(4), 602-609.
2.a)The article looked at Prem Baby P
which involved children below the age of
two.
2.Hodgetts, S., Savage, A. & McConnell, D. (2013)Experience and outcomes of stepping stones triple
P for families of children with autism. Research in Developmental Disabilities, 34 (9), 2572–2585
4.b)Effectiveness of Triple P was not
assessed using a questionnaire for
parents to evaluate their child’s
behaviour.
3.Petra, M. & Kohl, P. (2010). Pathways Triple P and the child welfare system: A promising fit.
Children and youth services review, 34(2), 611-618.
4.c) Sufficient empirical data were
reported for the calculation of standard
effect size
4. Sanders, M.R., Stallman, H. & McHale, M. (2011) Workplace Triple P: A controlled evaluation of a
parenting intervention for working parents. Journal of Family Psychology, 25(4), 581-590.
3.c)The intervention targets employed or
unemployed parents.
5. Spijkers, W., Jansen, D.E.M.C, de Meer, G. & Reijneveld, S.A. (2010) Effectiveness of a parenting
programme in a public health setting: a randomised controlled trial of the positive parenting
programme (Triple P) level 3 versus care as usual provided by the preventive child healthcare (PCH).
BMC Public Health, 10(1), 131-136
1.a) The study does not examine the
effects of Triple P, as an intensive
parenting programme for children with
conduct disorder/problems or who are at
risk of developing conduct
disorder/problems
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Appendix C Article summaries
Study and Aims
Sample
Sofronoff, Jahnel
& Sanders (2011)
To evaluate the
efficacy of the
Stepping Stones
Triple P seminars, a
brief group
intervention for
parents of a child
with a disability.
Control group size:
35
(Level 4)
Standard Triple P
Seminar format
Intervention
Stepping Stones
Triple P
There were two
Intervention group seminars that
size: 35
presented
parenting
Parental gender:
strategies to
92.5% female and
improve both child
7.5% male
behavior and
parenting variables
Child gender: Male implicated in the
71.7% and female
development and
28.3%
maintenance of
child problem
Child age range: 2- behavior.
10 years of age.
Design
The study was
carried out as an
RCT with a 2
(group) 3 (time)
design.
Assessments of
dependent
variables took
place prior to, six
weeks and three
months after the
workshop.
Measures
Eyberg Child
Behavior
Inventory (ECBI)
The inventory
measures
perceptions of
disruptive
behaviour in
children aged 2- 16
years of age. The
inventory
comprises of a
problem scale and
intensity scale.
Outcomes
ECBI
Problem scale
There were
significant
intervention
effects for the
Problem scale,
F(1,49) = 12.19, p =
.001,
Three month
follow up results
indicated a
significant
multivariate time
effect for reported
child behavior
problems, F(2,20) =
4.980, p = .018,
with significant
univariate effects
for both the ECBI
Problem scale
Intensity scale
42
Generalisability
and limitations
The study had a
small number of
participants which
may have
influenced a
finding of
significance for the
ECBI intensity
scale.
As none of the
participants were
blinded by their
intervention status
they may have
been influenced by
the placebo effect.
Data could have
been obtained
from other sources
to determine
changes in child
behaviour.
There was also a
very short follow
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No significant
multivariate
intervention
effects for the
Intensity scale,
F(1,49) = 3.845, p =
.056.
up interval of 3
months. Therefore,
caution is advised
when generalising
this studies
findings to other
studies
Three month
follow up results
indicated a
significant
multivariate time
effect for reported
intensity of
behaviours
F(1,21) = 7.801, p =
.011.
Fujiwara, Kato &
Sanders (2011)
Intervention group Group Triple P
Size: 91
comprises eight
sessions over an
To investigate the
Control group
eight-week period.
effectiveness of
Size: 24
Group Triple P with
The eight sessions
families in Japan,
Parent Gender: All are as follows: one
with the focus on
female
group session
child behaviour,
geared toward
parenting style and
providing an
parental
Control group
overview of the
adjustment
child gender: 56% program and
43
Quasi
experimental
design
Strengths and
Difficulties
Questionnaire
(SDQ) (parents)
Control-group
Measures parents
participants were
perceptions of pro
recruited along
social and difficult
with those of the
behaviours in their
intervention group, child.
during the same
*conduct scale
health check-ups.
Therefore
Child behaviour:
Significant
intervention effect
on the SDQ
conduct problems
subscale
(F (2, 108) = 6.11, p
= 0.003), with only
the intervention
group showing a
reduction, of 1.01
The information
obtained from this
study was from a
Japanese
population.
Therefore, it
cannot be
generalised to a UK
population.
In addition, the
parents were all
Doctorate in Educational and Child Psychology
(Level 4)
Standard Triple P
Group format
female and 44%
male
establishing
rapport within the
group (2 h each),
Intervention group three group
child gender: 67
sessions in which
male and 33%
parent training is
female
conducted (2 h
each),
Control group
three follow-up
child age range: 2- consultations by
3 years old.
telephone (15–30
min
each), and a final
Intervention group group session.
age range: 1-8
years old.
Recruitment:
Recruited from
mothers visiting
health clinics for
mandatory health
check-ups for their
children across
three suburban
residential area
near Tokyo. In
addition flyering
and public health
44
Pamela Hamilton
participants could
not be
randomized.
points (t = -5.89,
p\0.001).
women. Therefore,
the results cannot
be generalised to
programmes
where both
mothers and
fathers attend.
There was also no
follow up
undertaken so the
overall
generalizability of
effectiveness
cannot be
established
The above placebo
influence and
counter measures
are also applicable
to this study.
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Pamela Hamilton
nurses who
observed
behavioral
problems in
children were
asked to
recommend to
those children’s
mothers that they
should participate
in the study.
Sanders, Baker &
Turner (2012)
This study
examined the
consumer
outcomes,
programme
acceptability and
usage of Triple P
Online for parents
of children with
early-onset
disruptive
behaviour
problems in
Australia.
45
Intervention group Parents assigned to
Size: 60
the intervention
condition were
Control group
emailed
Size: 56
individual log in
details and were
Child age range: 2- prompted to
9 years old.
complete the
program within 3
months.
Child gender: 67% Access to the
male and 33%
program continued
female
until completion of
the 6-month
Parental gender:
follow-up
91% female 9%
assessment
male
This study was a
randomized,
controlled trial
employing a two
group (group: TPOL
vs internet-asusual control) _
Time (time:
pre-intervention,
post-intervention,
6-month followup) repeated
measures design.
On completion of
the study the
control group was
offered access to
Eyberg Child
Behavior
Inventory
SDQ (parents)
*conduct scale
Eyberg Child
Behavior
Inventory
Significant
condition effect, F
(2,111) ¼ 15.297, p
Observation of
¼ .000.
child disruptive
Univariate tests
behaviour – Family showed a
Observation
significant effect
Schedule
for both scales,
An observation of
the child’s
Problem scale
disruptive
TPOL parents
behaviour was
reporting
undertaken. The
significantly lower
The results could
be generalised to
some populations
within the UK due
to possible
overlapping
between Australian
and UK cultural
background and
parenting styles.
Furthermore, the
number of children
in the control and
intervention
groups were
relatively equally
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(Level 4)
Standard Triple P
Online format
Parental age
range: 25-50 years
of age
Recruitment:
Through
community
outreach in mass
media, online
parenting
forums, schools
and childcare
settings in
Brisbane, Australia.
Parents
self-identified as
having difficulties
with their child’s
disruptive
behaviour..
Pamela Hamilton
TPOL.
primary caregiver
and
target child were
observed during a
40-min videotaped
clinic
observation
including different
parenting tasksjoint free-play; and
clean-up
compliance task;
rate (Problem
scale) at post
intervention than
controls, with large
effect sizes
evident.
Intensity scale
TPOL parents
reported
significantly lower
frequency
(Intensity scale) of
behavior problems
at post
intervention than
controls, with large
effect sizes
evident.
SDQ (parents)
Significant
condition effect,
F(5,105) ¼ 3.690,p
¼ .004, with
significant
univariate effects
for the Conduct
and Emotion
46
matched
However, there
was a low
representation of
families with a low
SES. 76% of
participants had a
lower than average
SES.
There was a
reduced
observational
sample size due to
recording
difficulties.
Therefore, it would
be too hasty to
generalise such
limited
investigations.
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scales.
Again, parents in
the intervention
condition reported
significantly
reduced behavioral
and emotional
problems at
post-intervention
in comparison to
controls, with
medium effect
sizes. There were
no significant
univariate effects
for prosocial
Behavior.
Observation of
child disruptive
behaviour – Family
Observation
Schedule
Analysis of
observed child
disruptive behavior
revealed no
significant
condition effects,
F(1,38) ¼ .983, p ¼
47
Doctorate in Educational and Child Psychology
Pamela Hamilton
.328.
Follow up (6
months)
Eyberg Child
Behavior
Inventory
MANCOVA
revealed a
significant effect
for ECBI Problem
and
Intensity scores,
F(2,111) ¼ 10.619,
p ¼ .000.
SDQ (parents)
The short-term
effects on the SDQ
were not
maintained over
the 6-month
period, F(5,105) ¼
1.415, p ¼ .225.
Observation of
child disruptive
behaviour – Family
48
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Heinrichs, Kliem &
Hahlweg (2013)
To evaluate the 4year efficacy of the
group-based Triple
P as a prevention
program
administered
universally.
(Level 4)
Standard Triple P
Group format
49
Intervention
group: 186
Control group: 94
Child age range:
2.6 – 6 years
Child gender: 51%
boys, 49% girls
Pamela Hamilton
Triple P was
implemented in
four group sessions
that lasted 2 h
each. After the
completion of
group sessions,
parents were
offered four
weekly individual
telephone contacts
(15–20 min) to
discuss progress,
questions, and
difficulties with a
Triple P facilitator.
Seventeen
preschools
were randomly
assigned to Triple P
(n=11 preschools,
186 families) or a
no parenting
intervention
control group (n=6
preschools, 94
families).
Child Behavior
Checklist (CBCL 1
1/2–5 and CBCL 4–
18)
The German
versions of the
Child Behavior
Checklist
(CBCL) for children
aged 1 1/2–5 years
and 4–18 years
(Arbeitsgruppe
Deutsche Child
Behavior Checklist
1998; 2000) ask
parents to rate
presence and
Observation
Schedule
Analysis at followup revealed a
significant
condition effect for
observed child
disruptive
behavior,
F(1,23) ¼ 4.814, p
¼ .039,with a small
effect size.
Child Behavior
Checklist
Maternal child
behavior scores
decreased more in
the intervention
than in the control
group. No further
main
effects of group,
child gender, or
single parenthood
were
found either from
pre- to post-, or
during the followup
period. Fathers did
This study had a
four year efficacy
which provides
good evidence for
the maintenance
effect of Triple P.
There was also a
equal split of boys
and girls in the
intervention which
assists the data in
being more
generalizable.
Doctorate in Educational and Child Psychology
Pamela Hamilton
frequency of child
problem behaviors
and emotional
disturbances on
100 and 113 items,
respectively.
Laung, Fan &
Sanders (2013)
The study
examined the
effectiveness of
Group Triple P with
Chinese parents
who had a
preschool aged
child with a
developmental
disability.
(Level 4)
50
Intervention
group: 42
The Triple P Level 4
group version
consisted of eight
Wait list control
sessions, with six
group: 39
2-h group sessions
and two telephone
Control group
contact
parental gender:
follow-up sessions.
35 mothers, 4
All the participants
fathers
had to attend the
group sessions and
Intervention group complete
parental gender:
homework in
31 mothers, 4
between the group
The study
Eyberg Child
consisted of a
Behaviour
randomized
Inventory
control trial design.
A set of
questionnaires
were to be
completed by all
participants twice,
before and after
the
intervention.
Furthermore,
Intervention group
not report
significant
change in child
behavior at any
time. The
difference in
pre-4-year followup ES revealed a
small advantage
for the
intervention group
for the total score
of the CBCL
completed
by mothers
(ES=0.19).
ECBI - Intensity
the results were
significant for ECBIIntensity, F(1, 78) =
20.23–33.45, p <
.001, partial h2 =
.21–.30, d = 0.33,
95% CI [_0.11,
0.76] and
ECBI-Problem
The results were
significant for ECBIproblem F(1, 78) =
There was no
follow up for the
wait list control
group.
The study does not
list the genders of
the parents who
did not complete
pre and post
measures.
Doctorate in Educational and Child Psychology
Standard Triple P
Group format
51
fathers
sessions. The
group sessions
Intervention group consisted of minichild gender: 30
lectures,
females, 12 males
discussions, role
play and exercises.
Wait list control
The Triple P groups
group child
were conducted by
gender: 27 male,
the social workers
12 female
of SAHK who were
accredited Triple P
Recruitment:
Level 4 group
Promotion posters providers.
and application
forms were
distributed to all
parents
of children who
were receiving
services in the
Preschool Centres
of SAHK, including
two Early
Education and
Training
Centres, three
Special Child Care
Centres, four
Special Child Care
cum Early
Pamela Hamilton
participants were
requested to
complete these
questionnaires
again, at six
months after
program
completion
12.23–21.03, p <
.001, partial h2 =
.14–.21, d = 0.22,
95% CI [_0.22,
0.65].
Doctorate in Educational and Child Psychology
Education and
Training Centres,
and two Parents’
Resources Centres.
52
Pamela Hamilton
Doctorate in Educational and Child Psychology
Pamela Hamilton
Appendix D
Procedure for weighting studies
Studies were weighted according to ‘General design characteristics’, ‘Measures’,
‘Comparison group’ and ‘Analysis’ based on the Kratochwill (2003) coding protocol. Each
study was rated as being high, medium or low for each area.
The Weight of Evidence scores are based on:
A: Quality of methodology (Each question is awarded 0.5 point each for answer of yes, 0
for answer of No= total of 4.5. 2 points or less=low score, 2.5-3=medium score, 3.5+=high
score)
1. Was the study a randomised control trial in order to increase methodological rigour?
2. Was data was collected from at least 2 sources in order to analyse child behavioural
change?
3. Was data collected from at least 2 assessment methods?
4. Were the measures valid for the specific target audience?
5. Was enough information provided in order for effect size(s) to be calculated?
6. Did the sample size have 51 or more participants?
7. Were follow-up analysis on both control and intervention groups conducted?
8. Was there low attrition?
9. Was group equivalence established?
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B: Relevance of Methodology
To inspect if the methodological design of the studies were suitable for evaluating the
effectiveness of Triple P on the reduction/prevention of behavioural difficulties and conduct
problems the following was compiled.
(4 points are awarded for a high score)

To receive a high weighting for methodological relevance the study must have used
a random assignment of participants to the control or intervention group. They study
must have adjusted for confounding variables. Pre, post and follow-up measures
must have been obtained for all groups involved with the means and standard
deviations reported.
(3 points are awarded for a medium score)

To receive a medium weighting for methodological relevance the study must have
used a control group. Pre, post and follow up measures must have been obtained for
the intervention and control group.
(2 points are awarded for a low score)

To receive a low weighting, pre and post-test measure must have been obtained for
all groups involved.
C: Relevance of evidence to the review question
This table investigates if the studies contribute towards answering the review question.
54
Doctorate in Educational and Child Psychology
Pamela Hamilton
(4 points are awarded for a high score)

High- The study will have used a Triple P intervention with participants aged
between 2-11 years. Participants would have been identified as having elevated
levels of child behavioural problems through the analysis of multiple and established
sources of information (e.g. ECBI and observations) or parents requesting to
undertake Triple P training. Pre, post and follow up measures (6 months or more)
would have been undertaken. The means and standard deviations for the child
behaviour subscales of the child behaviour questionnaires would have been
reported.
(3 points are awarded for a medium score)

Medium- The study will have used a Triple P intervention with participants aged
between 2-11 years. Participants would have been identified as having elevated
levels of child behavioural problems through the analysis of established child
behaviour measure(s) or parents requesting to undertake Triple P training. Pre, post
and follow up measures (3 months or more) would have been undertaken.
(2 points are awarded for a low score)

Low- The study will have used a Triple P intervention with participants aged between
2-11 years. Participants would have been identified as having elevated levels of child
behavioural problems through the analysis of established child behaviour
measure(s). Pre and post measures would have been undertaken.
D: Overall Weight of evidence
55
Doctorate in Educational and Child Psychology
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The overall weight of evidence was calculated by combining the scores for WOE A, B and C.
Studies with 10 or more point were given a High Scores.
Studies with 8-9.5 points were given a Medium score
Studies with 7.5 points or below were given a low score.
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Appendix E
Coding protocol for reviewed studies
Coding Protocol
Name of Coder:
Date:30/01/14
Full Study Reference in proper format: 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.
Intervention Name (description of study): Level 4 Triple P
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the
following)
Very low (little basis)
57
Doctorate in Educational and Child Psychology
Pamela Hamilton
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study): 115
Intervention group sample size:91
Control group sample size:24
C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure
Prior exposure
Unknown
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No
Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary
outcomes (see following table for a detailed breakdown on the outcomes)
Yes
58
Doctorate in Educational and Child Psychology
Pamela Hamilton
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are
considered good, consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
3
2
1
0
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
59
Doctorate in Educational and Child Psychology
Pamela Hamilton
B3 Counterbalancing of change agent (participants who receive intervention from a single
therapist/teacher etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: Attrition rate not stated
Overall Level of Evidence 1
3= Strong Evidence 2=Promising Evidence
1=Weak Evidence
0=No Evidence
C Appropriate Statistical Analysis
Analysis 1 Strengths and Difficulties Questionnaire (parents)
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Analysis
2____________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Analysis
3____________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Overall Rating of Analysis:
60
3
2
1
0
Doctorate in Educational and Child Psychology
Name of Coder:
Pamela Hamilton
Date:02/02/2014
Full Study Reference in proper format: Heinrichs, N., Kliem, S., & Hahlweg, K. (2013). Four-year follow-up of a
randomized controlled trial of triple p group for parent and child outcomes. Prevention Science, 1-13.
Intervention Name (description of study): Group Triple P (level 4)
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the following)
Very low (little basis)
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study):280
Intervention group sample size:186
Control group sample size:94
61
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C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure
Prior exposure
Unknown
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary outcomes (see
following table for a detailed breakdown on the outcomes)
Yes
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are considered good,
consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
62
3
2
1
0
Doctorate in Educational and Child Psychology
Pamela Hamilton
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
B3 Counterbalancing of change agent (participants who receive intervention from a single therapist/teacher
etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: 10% attrition over the 4 year follow up period. Post intervention attrition data not stated
Overall Level of Evidence 2
3= Strong Evidence
2=Promising Evidence
1=Weak Evidence
0=No Evidence
C Appropriate Statistical Analysis
Analysis 1____________________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Analysis 2____________________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
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Analysis 3____________________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Overall Rating of Analysis:
64
3
2
1
0
Doctorate in Educational and Child Psychology
Name of Coder:
Pamela Hamilton
Date:02/02/14
Leung, C., Fan, A. & Sanders, M.R. (2013). The effectiveness of a group triple p with chinese
parents who have a child with developmental disability: a randomized controlled trial.
Research in Developmental Disabilities, 34, 976-984.
Intervention Name (description of study):Triple P (Level 4)
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the following)
Very low (little basis)
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study): 81
Intervention group sample size:39
Control group sample size:35
65
Doctorate in Educational and Child Psychology
Pamela Hamilton
C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure
Prior exposure
Unknown
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary outcomes (see
following table for a detailed breakdown on the outcomes)
Yes
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are considered good,
consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
66
3
2
1
0
Doctorate in Educational and Child Psychology
Pamela Hamilton
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
B3 Counterbalancing of change agent (participants who receive intervention from a single therapist/teacher
etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: Post intervention attrition rate of 9% and follow-up attrition rate of 14 % (control group only)
Overall Level of Evidence 2
3= Strong Evidence
2=Promising Evidence
67
1=Weak Evidence
0=No Evidence
Doctorate in Educational and Child Psychology
Pamela Hamilton
C Appropriate Statistical Analysis
Analysis 1Eyberg Child Behaviour Inventory
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Analysis 2____________________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Analysis 3____________________________________________________________________________
Appropriate unit of analysis
Familywise/expermenter wise error rate controlled when applicable
Sufficiently large N
Overall Rating of Analysis:
68
3
2
1
0
Doctorate in Educational and Child Psychology
Name of Coder:
Pamela Hamilton
Date:30/01/14
Full Study Reference in proper format: Sanders, M.R., Baker, S. & Turner, K.M.T. (2012). A
randomized controlled trial evaluating the efficacy of triple p online with parents of children
with early onset conduct problems. Behaviour Research and Therapy, 50, 675-684
Intervention Name (description of study): Triple P Online (Level 4)
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the following)
Very low (little basis)
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study): 116
Intervention group sample size:60
Control group sample size:56
C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
69
Doctorate in Educational and Child Psychology
Pamela Hamilton
Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure
Prior exposure
Unknown – Parent/child current exposure to professional emotional/behavioural services was an
exclusion criteria
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary outcomes (see
following table for a detailed breakdown on the outcomes)
Yes
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are considered good,
consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
70
3
2
1
0
Doctorate in Educational and Child Psychology
Pamela Hamilton
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
B3 Counterbalancing of change agent (participants who receive intervention from a single therapist/teacher
etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: 8 % attrition rate post intervention and 14 % attrition rate at follow-up
Overall Level of Evidence 3
3= Strong Evidence
2=Promising Evidence
71
1=Weak Evidence
0=No Evidence
Doctorate in Educational and Child Psychology
Name of Coder:
Pamela Hamilton
Date:30/01/14
Full Study Reference in proper format: Sanders, M.R., Baker, S. & Turner, K.M.T. (2012). A
randomized controlled trial evaluating the efficacy of triple p online with parents of children
with early onset conduct problems. Behaviour Research and Therapy, 50, 675-684
Intervention Name (description of study): Triple P Online (Level 4)
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the following)
Very low (little basis)
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study): 116
Intervention group sample size:60
Control group sample size:56
C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
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Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure
Prior exposure
Unknown – Parent/child current exposure to professional emotional/behavioural services was an
exclusion criteria
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary outcomes (see
following table for a detailed breakdown on the outcomes)
Yes
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are considered good,
consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
73
3
2
1
0
Doctorate in Educational and Child Psychology
Pamela Hamilton
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
B3 Counterbalancing of change agent (participants who receive intervention from a single therapist/teacher
etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: 8 % attrition rate post intervention and 14 % attrition rate at follow-up
Overall Level of Evidence 3
3= Strong Evidence
2=Promising Evidence
1=Weak Evidence
0=No Evidence
C Appropriate Statistical Analysis
Analysis 1Eyberg Child Behaviour Inventory
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Analysis 2 Strengths and Difficulties Questionnaire (parent)
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Analysis 3 Observation of child disruptive behaviour – Family Observation Schedule
74
Doctorate in Educational and Child Psychology
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Overall Rating of Analysis:
75
3
2
1
0
Pamela Hamilton
Doctorate in Educational and Child Psychology
Name of Coder:
Pamela Hamilton
Date:04/02/14
Full Study Reference in proper format:_ Sofronoff, K., Jahnel, D., & Sanders, M. (2011). Stepping
Stones Triple P seminars for parents of a child with a disability: a randomized controlled
trial. Research in Developmental Disabilities, 32(6), 2253-2262.
Intervention Name (description of study):Stepping Stones Triple P
Study ID Number:__________________
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
1.General Characteristics
A. General Design Characteristics
A1. Random assignment designs (if random assignment design, select one of the following)
Completely randomized design
Randomized block design (between participants, e.g., matched classrooms)
Randomized block design (within participants)
Randomized hierarchical design (nested treatments
A2. Nonrandomized designs (if non-random assignment design, select one of the following)
Nonrandomized design
Nonrandomized block design (between participants)
Nonrandomized block design (within participants)
Nonrandomized hierarchical design
Optional coding for Quasi-experimental designs
A3. Overall confidence of judgment on how participants were assigned (select on of the following)
Very low (little basis)
Low (guess)
Moderate (weak inference)
High (strong inference)
Very high (explicitly stated)
N/A
Unknown/unable to code
B Participants
Total size of sample (start of study): 70
Intervention group sample size:35
Control group sample size:35
76
Doctorate in Educational and Child Psychology
Pamela Hamilton
C. Type of Program
Universal prevention program
Selective prevention program
Targeted prevention program
Intervention/Treatment
Unknown
D. Stage of Program
Model/demonstration programs
Early stage programs
Established/institutionalized programs
Unknown
E. Concurrent or Historical Intervention Exposure
Current exposure -38% of parents reported that they were currently seeking professional help for their
child’s EBD problems.
Prior exposure
Unknown
Section 2
Key Features for Coding Studies and Rating Level of Evidence/Support
A Measurement (Estimating the quality of the measures used to establish effects)
(Rating Scale: 3= Strong Evidence, 2=Promising Evidence, 1=Weak Evidence, 0=No Evidence)
A1 The use of the outcome measures produce reliable scores for the majority of the primary outcomes (see
following table for a detailed breakdown on the outcomes)
Yes
No
Unknown/unable to code
A2 Multi-method (at least two assessment methods used)
Yes
No
N/A
Unknown/unable to code
A3 Multi-source (at least two sources used self-reports, teachers etc.)
Yes
No
N/A
Unknown/unable to code
A4 Validity of measures reported (well-known or standardized or norm-referenced are considered good,
consider any cultural considerations)
Yes validated with specific target group
In part, validated for general population only
No
Unknown/unable to code
Overall Rating of Measurement:
77
3
2
1
0
Doctorate in Educational and Child Psychology
Pamela Hamilton
B Comparison Group
B1 Type of Comparison group
Typical intervention
Attention placebo
Intervention element placebo
Alternative intervention
Pharmacotherapy
No intervention
Wait list/delayed intervention
Minimal contact
Unable to identify type of comparison
B2 Overall rating of judgment of type of comparison group
Very low
Low
Moderate
High
Very high
Unable to identify comparison group
B3 Counterbalancing of change agent (participants who receive intervention from a single therapist/teacher
etc were counter-balanced across intervention)
By change agent
Statistical (analyse includes a test for intervention)
Other
Not reported/None
B4 Group equivalence established
Random assignment
Posthoc matched set
Statistical matching
Post hoc test for group equivalence
B5 Equivalent mortality
Low attrition (less than 20 % for post)
Low attrition (less than 30% for follow-up)
Intent to intervene analysis carried out?
Findings: 23% attrition rate post intervention and 37% attrition rate at follow-up (control
group only)
Overall Level of Evidence 1
3= Strong Evidence
2=Promising Evidence
78
1=Weak Evidence
0=No Evidence
Doctorate in Educational and Child Psychology
Pamela Hamilton
C Appropriate Statistical Analysis
Analysis 1 Eyberg Child Behavior Inventory (ECBI)
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Analysis 2____________________________________________________________________________
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Analysis 3____________________________________________________________________________
Appropriate unit of analysis
Familywise/experimenter wise error rate controlled when applicable
Sufficiently large N
Overall Rating of Analysis:
79
3
2
1
0