Triple P - Enhanced group behavioural family intervention

About the program

EBFI is an enhanced version of Triple P. It is a group program that incorporates attributional retraining and anger management.

Broadly, EBFI aims to reduce risk factors for child maltreatment. In the program parents are taught to:

• challenge the beliefs they hold about their child's and their own behaviour and how to change negative behaviours in line with these beliefs
• promote children’s competence and development (e.g. praise)
• manage children’s misbehaviour (e.g. setting rules)
• manage their own anger using physical, cognitive and planning strategies

See also the following Program Summaries in the Preventing Child Maltreatment Evidence Review:

• Triple P
• Group Teen Triple P

See also the Self-Directed Triple P Program Summary in the Reducing Child Harm and Maltreatment Evidence Review.

Who does it work for?

EBFI aims to reach parents:

• experiencing significant difficulties in managing their own anger when interacting with their preschool-aged children
• at risk of child maltreatment
• who are concerned about their anger or that they might harm their own child.

EBFI has only been evaluated in Australia (Sanders et al. 2004).

A randomized control trial was conducted with 74 people (35 in the intervention group and 39 in the control group). On average, parents were 34 years old, children were 53 months old.  Aboriginal and CALD status was not noted in the RCT (Sanders et al. 2004). It is unclear if this program is effective for these groups.

The program has not been evaluated with (1) families receiving intensive ongoing family therapy or psychotherapeutic interventions or (2) families with a child or parent with a significant intellectual impairment.

What outcomes does it contribute to?

Positive Outcomes:

• Parenting Attitude:
  • Parents who completed the EBFI were more likely to reduce their attributions for child behaviour. That is, their ability to attribute blame and real-intent to their children’s actions improved.
  • Parent’s unrealistic expectations of children’s behavior also improved.
• Child Abuse Potential: the potential for child abuse was significantly reduced in parents who completed the EBFI, compared to parents who only completed the standard Triple P program.

No effect:

• Parent’s Mental Health: the program did not have an effect on parent’s experience or expression of anger. The program also did not have an effect on parental adjustment, including depression and anxiety and the ability of families to work together in family management
• Parenting Stress: the program did not have an effect on anger experienced by parents in response to their child’s behavior.
• General Parenting Behaviours: the program did not have an effect on general parenting behaviours, e.g. laxness, over-reactivity and overly long reprimands or reliance on talking.

Negative outcomes:

• No negative effects were found.

How effective is it?

Overall, the program had a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

EBFI is an enhanced version of Triple P. As such, it builds on the standard program by delivering an additional 4 group sessions that address risk factors for child abuse and neglect.

The EBFI program consists of:

• Four 2hr group sessions of parent training
• Four 2h group sessions targeting the additional risk factors
• Four 15-30min individual telephone consultations.

Active training methods such as modeling, rehearsal practice, feedback and goal setting were used to teach specific parenting skills throughout the program.

Parents also received a copy of:

• Every Parent’s Group Workbook which contains the key learning principles of the program and exercises to complete during and between sessions.
• An additional workbook that outlines the principles taught in the additional modules focusing on attributions and anger management.

The program typically took 12 weeks to complete.

Detailed written protocols specifying the content of each session, in-session exercises to complete, and homework tasks were developed.

Sessions on Parenting Training

The program teaches parents 17 core child management strategies. Ten of the strategies promote children’s competence and development (e.g. praise, engaging activities, incidental teaching). Seven of the strategies help parents manage misbehaviour (e.g. setting rules, quiet time, time out).

In addition, parents are taught a planned activities routine to enhance the generalisation and maintenance of parenting skills. Planned activities training teaches parents how to anticipate and prepare for high-risk situations (e.g. when children are tired or bored), and how to plan age-appropriate activities for these situations.

Parents are taught to apply parenting skills to a broad range of target behaviours in both home and community settings with their children. Parents learn to set and monitor goals for behaviour change and to enhance their skills in observing their child's and their own behaviour.

Sessions targeting additional risk factors

In the additional sessions parents were:

• taught skills to challenge the beliefs they hold regarding their own behaviour and the behaviour of their child
• taught skills to change any negative practices they current use in line with these beliefs.
• introduced to physical, cognitive and planning strategies to manage their anger.

How much does it cost?

Not reported.

What else should I consider?

Sanders et al. (2004) conducted the only research on the effectiveness of the EBFI program, compared with the traditional Triple P program. The outcomes of the research only highlight whether EBFI is more effective than Triple P.

Sanders et al. (2004) conclude that while short-term outcomes are improved using the EBFI version of Triple P, long term outcomes have similar results as the original program. This has been hypothesized to be due to the group socialisation aspect of both versions.

Where does the evidence come from?

1 RCT conducted in Australia, with a sample of 74 people (Sanders et al. 2004).

Further resources

For more information about Triple P see: https://www.triplep.net/glo-en/home/

Sanders et al. (2004), ‘Does Parental Attributional Retraining and Anger Management Enhance the Effects of the Triple P-Positive Parenting Program With Parents at Risk of Child Maltreatment?’, Behavior Therapy, vol. 35, pp. 513-535.