Address for correspondence: Matthew R. Sanders, Parenting and Family Support Centre, The University of Queensland, St Lucia QLD 4072, Australia Email: m.sanders@psy.uq.edu.au Copyright 2003 The Parenting and Family Support Centre, The University of Queensland ISBN 1 875378 46 4 Theoretical, Scientific and Clinical Foundations of the Triple P‐Positive Parenting Program: A Population Approach to the Promotion of Parenting Competence Matthew R. Sanders, Carol Markie‐Dadds and Karen M.T. Turner Parenting and Family Support Centre, The University of Queensland This paper outlines the theoretical, empirical and clinical foundations of a unique parenting and family support strategy designed to reduce the prevalence of behavioural and emotional problems in children and adolescents. The program known as the Triple P-Positive Parenting Program is a multi-level system of family intervention, which provides five levels of intervention of increasing strength. These interventions include a universal population-level media strategy targeting all parents, two levels of brief primary care consultations targeting mild behaviour problems and two more intensive parent training and family intervention programs for children at risk for more severe behavioural problems. The program aims to determine the minimally sufficient intervention a parent requires in order to deflect a child away from a trajectory towards more serious problems. The self- regulation of parental skill is a central construct in the program. The program uses flexible delivery modalities (including individual face-to-face, group, telephone-assisted and self-directed programs) to tailor the strength and format of the intervention to the requirements of individual families. Its multi-disciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatised access points through primary care services for families who are reluctant to participate in parenting skills programs. The available empirical evidence supporting the efficacy of the program and its implications for research on dissemination are discussed. The quality of family life is fundamental to the wellbeing of children. Family relationships in general and the parent-child relationship in particular have a pervasive influence on the psychological, physical, social and economic wellbeing of children. Many significant mental health, social and economic problems are linked to disturbances in family functioning and the breakdown of family relationships (Chamberlain & Patterson, 1995; Patterson, 1982; Sanders & Duncan, 1995). Epidemiological studies indicate that family risk factors such as poor parenting, family conflict and marriage breakdown strongly influence children’s development (e.g., Cummings & Davies, 1994; Dryfoos, 1990; Robins, 1991). Specifically, a lack of a warm positive relationship with parents; insecure attachment; harsh, inflexible, rigid or inconsistent discipline practices; inadequate supervision of and involvement with children; marital conflict and breakdown; and parental psychopathology (particularly maternal depression) increase the risk that children will develop major behavioural and emotional problems, including substance abuse, antisocial behaviour and juvenile crime (e.g., Coie, 1996; Loeber & Farrington, 1998). Although family relationships are important, parents generally receive little preparation beyond the experience of having been parented themselves; with most learning on the job, through trial and error (Risley, Clark, & Cataldo, 1976; Sanders et al., 2000). The demands of parenthood are further complicated when parents do not have access to extended family support networks (e.g., grandparents or trusted family friends) for advice on child rearing, do not have partners, or experience the stress of separation, divorce or repartnering (Lawton & Sanders, 1994; Sanders, Nicholson, & Floyd, 1997). This paper describes the conceptual and empirical foundations of the program’s comprehensive model of parenting and family support, which aims to better equip parents in their child rearing role. The program’s unique features, derivative programs and issues involved in the effective dissemination of the system are discussed and directions for future research are highlighted. WHA T IS THE TRIPLE P – PO SITIVE PA RENTING PRO G RA M? The Triple P-Positive Parenting Program is a multi-level, preventively-oriented parenting and family support strategy developed by the authors and colleagues at The University of Queensland in Brisbane, Australia. The program aims to prevent severe behavioural, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents. It incorporates five levels of intervention on a tiered continuum of increasing strength (see Table 1) for parents of children and adolescents from birth to age 16. Figure 1 depicts the differing levels of intensity and reach of the Triple P system. Level 1, a universal parent information strategy, provides all interested parents with access to useful information about parenting through a coordinated promotional campaign using print and electronic media as well as user-friendly parenting tip sheets and videotapes that demonstrate specific parenting strategies. This level of intervention aims to increase community awareness of parenting resources and the receptivity of parents to participating in programs, and to create a sense of optimism by depicting solutions to common behavioural and developmental concerns. Level 2 is a brief, one to two-session primary health care Pa re nting Re se a rc h a nd Pra c tic e Mo no g ra p h No . 1