The efficacy of the Triple P-Positive Parenting Program in improving parenting and child behavior: A comparison with two other treatment conditions

Abstract

The aim of this randomized controlled trial was to evaluate the efficacy of an evidence-based parenting program (the Triple P-Positive Parenting Program), intending to improve parenting skills and children's well-being. Parents participating in a Group Triple P program (n=50 couples) were compared with parents of a non-treated control group (n=50 couples) and parents participating in a marital distress prevention program (couples coping enhancement training (CCET)) (n=50 couples). The two major goals of this study were (a) to evaluate the efficacy of Triple P compared with the two other treatment conditions over a time-span of 1 year and (b) to answer the question whether this program that was developed in Australia is culturally accepted by Swiss parents. Results revealed that Triple P was effective with Swiss families. Mothers of the Triple P group showed significant improvements in parenting, parenting self-esteem, and a decrease in stressors related to parenting. Women trained in Triple P also reported significantly lower rates of child's misbehavior than women of the two other conditions. However, in men only a few significant results were found. Positive effects of the relationship training (CCET) were somewhat lower than those for the Triple P. These findings are further discussed.

Introduction

Studies in Germany and Switzerland as well as in other countries indicate that the prevalence of clinically significant child disorders and conduct problems is between 18% and 22% (e.g., Anderson & Werry, 1994; Lehmkuhl et al., 1998; Steinhausen & Winkler Metzke, 1997; Verhulst, 1995). Even more children (28%) are labeled as difficult by their parents (Sanders et al., 1999). These findings represent an important and disquieting phenomenon of modern societies. Spence (1998) argued that multiple factors contribute to the development of a child's dysfunctions and that risk factors may interact in a multiplicative and not only additive manner. Thus, several studies reveal that apart from child factors (e.g., temperament of the child), environmental factors (e.g., low income, crowded or dangerous neighborhoods, the influence of peers, media, inadequate social support networks), and family variables (e.g., poor parenting, marital distress of the parents, parental psychopathology) figure among the most powerful predictors of negative child outcomes (e.g., Aviezer, Sagi-Schwartz, & Koren-Karie, 2003; Erel & Burman, 1995; Grych & Fincham, 1990; Loeber & Farrington, 1998; Rapee, 1997; Spence, 1998). In this study, we focus on two well-known risk factors: (a) poor parenting (characterized by a lack of a supporting and warm relationship between parents and the child, a lack of maternal responsiveness, as well as inconsistent or rigid and punishing rearing practices) and (b) frequent exposure of the child to marital conflicts (characterized by high negativity in dyadic interaction, escalation or withdrawal). The reasons justifying these two targets are threefold. First, empirical evidence shows that both risk factors are among the most powerful predictors of child disorders. Secondly, both risk factors might be positively influenced by preventive interventions (which is not so evident regarding other risk factors such as parental psychopathology and/or poverty). Lastly, evidence-based prevention programs exist to intervene in families. Along similar lines, Sanders, Markie-Dadds, and Nicholson (1997) argued that prevention efforts should focus on strengthening both the parenting and marital relationship in order to promote healthy family functioning and child well-being. As effective prevention programs to strengthen parenting competencies (e.g., Sanders, Markie-Dadds, Tully, & Bor, 2000) and enhance marital quality (e.g., Jakubowski, Milne, Brunner, & Miller, 2004) exist, our interest was in comparing both ways of strengthening family functioning. We did so by offering couples either an evidence-based parenting-oriented program (Triple P) or an evidence-based marriage-oriented prevention program (couples coping enhancement training (CCET)). It was hypothesized that enhanced parenting as well as a more harmonious marriage promote a more supportive family atmosphere which then creates a healthier family environment to raise children (e.g., Cowan & Cowan, 2000; Feinberg, 2002; Sanders et al., 1997).

While a number of previous studies have evaluated the efficacy of Triple P, to date there are no studies that have compared the effects of interventions focusing on either marriage or parenting on child and parenting outcomes in a single study. This question is intriguing for several reasons. Firstly, several studies have shown that marital relationships and parenting are related to each other (see Krishnakumar & Buehler, 2000) and that parenting programs can also enhance marital quality (Dadds, Schwartz, & Sanders, 1987). Additionally, marital distress prevention programs not only have shown positive effects on marital quality (e.g., Halford, Markman, Kline, & Stanley, 2003; Shadish & Baldwin, 2003), but also on parenting (e.g., Cowan & Cowan, 2000; Sanders et al., 1997). Although an improvement of marital quality is associated with better child outcomes (e.g., Kanoy, Ulku-Steiner, Cox, & Burchinal, 2003; Wilson & Gottman, 1995), we hypothesize that an improvement of parenting has a more proximal effect on child well-being and as a result should produce a stronger effect. This study is aimed at addressing this question by comparing an evidence-based parenting program (the Triple P-Positive Parenting Program) with an evidence-based marital distress prevention program (CCET) and a non-treated control group. The design of this study controls for the effects of positive expectancies (by use of the control condition) and of marital improvement (by use of the marriage-oriented approach), thus allowing us to contribute a genuine improvement due to an enhancement of parenting. A second aim of this study is to evaluate the efficacy of Triple P in a European, predominantly non-English-speaking country (Switzerland); previously most of the studies regarding the efficacy of Triple P have been conducted in English-speaking countries. As one of the first studies to evaluate the efficacy of Tripe P with a European sample, we hope to address whether this program works in another cultural context.

The following hypotheses were tested: (1) Couples learning particular parenting strategies in a Triple P program would benefit more in terms of changes in parenting and the up-bringing of children than control couples (without any specific intervention); (2) parents participating in Triple P would show better effects than parents in the CCET condition, as Triple P focuses more precisely on the improvement of parenting (one key-dependent variable); (3) both intervention programs (Triple P and CCET) would show similar effects on child out-comes and (4) mothers would benefit more from Triple P than fathers due to the fact that the former are more likely to be involved in child rearing, specifically seen in Switzerland.