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The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support
Abstract
This systematic review and meta-analysis examined the effects of the multilevel Triple P-Positive Parenting Program system on a broad range of child, parent and family outcomes. Multiple search strategies identified 116 eligible studies conducted over a 33-year period, with 101 studies comprising 16,099 families analyzed quantitatively. Moderator analyses were conducted using structural equation modeling. Risk of bias within and across studies was assessed. Significant short-term effects were found for: children's social, emotional and behavioral outcomes (d=0.473); parenting practices (d=0.578); parenting satisfaction and efficacy (d=0.519); parental adjustment (d=0.340); parental relationship (d=0.225) and child observational data (d=0.501). Significant effects were found for all outcomes at long-term including parent observational data (d=0.249). Moderator analyses found that study approach, study power, Triple P level, and severity of initial child problems produced significant effects in multiple moderator models when controlling for other significant moderators. Several putative moderators did not have significant effects after controlling for other significant moderators. The positive results for each level of the Triple P system provide empirical support for a blending of universal and targeted parenting interventions to promote child, parent and family wellbeing.
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“Furthermore, the lack of statistically significant subgroup results by program duration, delivery modality, and setting are also consistent with the few prior meta-analyses that have conducted similar analyses and shown no associations between these program aspects and intervention effects on ECD and parent-level outcomes [62].”
From Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis (2021) · cites this paper as [62]
In the citing paper
“The lack of statistically significant subgroup results by child age are consistent with the few prior meta-analyses that have similarly shown no age effects among parenting interventions focused during early childhood [9,22] or spanning broader age ranges from early to middle childhood [49] or birth to age 18 [62].”
From Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis (2021) · cites this paper as [62]
In the citing paper
“Specific intervention programs including the Circle of Security (Hoffman et al., 2006; Powell et al., 2014), Triple P (Positive Parenting Program) (Sanders et al., 2014), Video Interaction for Promoting Positive Parenting Programme (Van Zeijl et al., 2006), and Mom Power (Muzik et al., 2015), have been validated according to randomized clinical trial approaches.”
From The maternal brain and its plasticity in humans (2016) · cites this paper as Sanders et al., 2014
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“Specific intervention programs including the Circle of Security (Hoffman et al., 2006; Powell et al., 2014), Triple P (Positive Parenting Program) (Sanders et al., 2014), Video Interaction for Promoting Positive Parenting Programme (Van Zeijl et al., 2006), and Mom Power (Muzik et al., 2015), have been validated accor…”
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BackgroundFamily therapy and systemic interventions for child‐focused problems: the current evidence base
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Mingebach, T., Kamp‐Becker, I., Christiansen, H., & Weber, L. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202855 · Cited by 259
Family environment and self-esteem development: A longitudinal study from age 10 to 16.
Krauss, S., Orth, U., & Robins, R. W. (2020) · Journal of Personality and Social Psychology · doi:10.1037/pspp0000263 · Cited by 209
Effective Discipline to Raise Healthy Children
Sege, R. D., Siegel, B., Flaherty, E. G., Gavril, A. R., Idzerda, S. M., Laskey, A. L., Legano, L. A., Leventhal, J. M., Lukefahr, J. L., Yogman, M. W., et al. (2018) · PEDIATRICS · doi:10.1542/peds.2018-3112 · Cited by 210
Molnar, B. E., Sprang, G., Killian, K. D., Gottfried, R., Emery, V., & Bride, B. E. (2017) · Traumatology An International Journal · doi:10.1037/trm0000122 · Cited by 253
“Professional skills training as a form of prevention and treatment for STS is a strategy that is supported by correlational studies suggesting that individuals who received instruction in evidencebased practices for treating traumatic stress conditions had lower levels of STS (Sprang et al., 2007). In addition, resear…”
BackgroundThe Role of Parents, Parenting and the Family Environment in Children’s Post-Disaster Mental Health
Cobham, V. E., McDermott, B., Haslam, D., & Sanders, M. R. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0691-4 · Cited by 238
Evidence-Based Interventions for Depressed Mothers and Their Young Children
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Staunton, E., Kehoe, C., & Sharkey, L. (2020) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2020.4 · Cited by 170
“Some evidence-based groupparenting training programs have been shown to improve parental well-being and reduce parental stress such as Parents Plus (Carr et al. 2016) and Triple P-Positive Parenting Program (Sanders et al. 2014).”
BackgroundKearney, C. A., & Graczyk, P. A. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00317-1 · Cited by 157
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“While there is a lack of research on the longer-term effects of parenting programmes, studies have found that positive outcomes for children are maintained (Sanders et al. 2014), even up to 8–10 years after intervention (Webster-Stratton et al.”
BackgroundInfluentialPositive parenting improves multiple aspects of health and well-being in young adulthood
Chen, Y., Haines, J., Charlton, B. M., & VanderWeele, T. J. (2019) · Nature Human Behaviour · doi:10.1038/s41562-019-0602-x · Cited by 157
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“Meta-analyses have demonstrated smaller effect sizes for changes in fathers’ ratings of parenting and child behaviour compared with mothers’ ratings [18, 25], although it should be noted that many studies do not report on outcome measures separately for mothers and fathers [5, 12].”
ResultFuture Directions for Psychosocial Interventions for Children and Adolescents with ADHD
DuPaul, G. J., Evans, S. W., Mautone, J. A., Owens, J. S., & Power, T. J. (2019) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1689825 · Cited by 153
Promoting Self-Regulation in Young Children: The Role of Parenting Interventions
Morawska, A., Dittman, C. K., & Rusby, J. C. (2019) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-019-00281-5 · Cited by 163
Positive maternal mental health, parenting, and child development
Phua, D. Y., Kee, M. Z. L., & Meaney, M. J. (2020) · Biological Psychiatry · doi:10.1016/j.biopsych.2019.09.028 · Cited by 124
First onset of suicidal thoughts and behaviours in college
Mortier, P., Demyttenaere, K., Auerbach, R. P., Cuijpers, P. J., Green, J. G., Kiekens, G., Kessler, R. C., Nock, M. K., Zaslavsky, A. M., & Bruffaerts, R. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.033 · Cited by 125
“Public health strategies for childhood maltreatment prevention, such as increasing parenting support (Prinz, 2016; Sanders et al., 2014), or school-based interventions (Stanley et al.”
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“Evidence supports Triple P’s effectiveness at each level (Sanders et al. 2014).”
BackgroundInfluentialA Systematic Review of Parent and Caregiver Mental Health Literacy
Hurley, D., Swann, C., Allen, M., Ferguson, H. L., & Vella, S. (2019) · Community mental health journal · doi:10.1007/s10597-019-00454-0 · Cited by 99
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“When RCTs are not feasible, mixed method designs including qualitative and quantitative methods addressing research questions can help with cultural adaptation evaluations (Carey et al. 2015).”
BackgroundInfluentialBaker, S., Sanders, M. R., Turner, K., & Morawska, A. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.016 · Cited by 100
Dadds, M. R., & Tully, L. A. (2019) · American Psychologist · doi:10.1037/amp0000449 · Cited by 99
Scaling Up Parenting Interventions is Critical for Attaining the Sustainable Development Goals
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“These include the use of broadcast television programs [50] and radio programs or podcasts [51] online or mobile app based parenting interventions [52] large and small group preventive seminars and workshops [37], and more intensive multi-session group and individual programs for families with complex needs [25].”
BackgroundGardner, F., Leijten, P., Melendez-Torres, G. J., Landau, S., Harris, V., Mann, J., Beecham, J., Hutchings, J., & Scott, S. (2019) · Child Development · doi:10.1111/cdev.13138 · Cited by 95
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Toward Father‐friendly Parenting Interventions: A Qualitative Study
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“Whereas there is some meta-analytic evidence for greater effects of positive parenting interventions for younger children as compared with older children when examining socio-emotional and behavioural outcomes (Gardner et al., 2010; Sanders et al., 2014), other meta-analyses do not support this claim (Gardner et al.”
BackgroundResultInfluentialThe prevention of violence in childhood through parenting programmes: a global review
Coore-Desai, C., Reece, J.-A., & Shakespeare‐Pellington, S. (2017) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1271952 · Cited by 91
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“However, small cell sizes precluded moderation and sensitivity analyses pertinent to this aspect of design, as are typically conducted (Griner and Smith 2006; Sanders et al. 2014).”
BackgroundInfluentialDoyle, F. L., Morawska, A., Higgins, D. J., Havighurst, S. S., Mazzucchelli, T. G., Toumbourou, J. W., Middeldorp, C. M., Chainey, C., Cobham, V. E., Harnett, P. H., et al. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01309-0 · Cited by 88
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Weber, L., Kamp‐Becker, I., Christiansen, H., & Mingebach, T. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1175-3 · Cited by 88
“…Meta–meta-analysis of parental mental health (postintervention) RE−Model −0.30 0.00 0.30 0.60 0.90 SMD Tellegen & Sanders, 2013 Serketich & Dumas, 1996 Sanders et al., 2014 Nowak & Heinrichs, 2008 Furlong et al., 2012 Barlow et al., 2014 0.61% 0.32 [ 0.13 , 0.51 ] 20.08% 0.44 [ −0.15 , 1.03 ]…”
InfluentialDadds, M. R., Sicouri, G., Piotrowska, P. J., Collins, D., Hawes, D. J., Moul, C., Lenroot, R., Frick, P. J., Anderson, V. A., Kimonis, E. R., et al. (2018) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2018.1485109 · Cited by 91
“…on improving the quality and consistency of parenting practices, are regarded as the gold standard treatment for children with behavioral problems (Comer, Chow, Chan, Cooper-Vince, & Wilson, 2013; Eyberg, Nelson, & Boggs, 2008; Kaminski & Claussen, 2017; Sanders, Kirby, Tellegen, & Day, 2014).”
BackgroundEvolving a More Nurturing Society to Prevent Adverse Childhood Experiences
Biglan, A., Ryzin, M. J. V., & Hawkins, J. D. (2017) · Academic Pediatrics · doi:10.1016/j.acap.2017.04.002 · Cited by 92
Chandra‐Mouli, V., Plesons, M., Adebayo, E., Amin, A., Avni, M., Kraft, J. M., Lane, C. S., Brundage, C. L., Kreinin, T., Bosworth, E., et al. (2017) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2017.07.012 · Cited by 85
“Parenting interventions that have shown some efficacy in improving parenting skills include Triple P and the Incredible Years [16,17].”
Parenting and child mental health
Ryan, R., O’Farrelly, C., & Ramchandani, P. G. (2017) · London Journal of Primary Care · doi:10.1080/17571472.2017.1361630 · Cited by 101
Hansen, A., Broomfield, G., & Yap, M. B. H. (2019) · Australian Journal of Psychology · doi:10.1111/ajpy.12250 · Cited by 82
Bjørseth, Å., & Wichstrøm, L. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159845 · Cited by 77
Carr, A., Hartnett, D., Brosnan, E., & Sharry, J. (2016) · Family Process · doi:10.1111/famp.12225 · Cited by 74
“…size of 0.57 from our meta-analysis of 10 controlled studies of PP programs for child behavior problems compares very favorably with those of 0.3 and 0.47 from metaanalyses of the Incredible Years (Menting et al., 2013) and Triple P (Sanders et al., 2014) parent training programs, respectively.”
BackgroundResultInfluentialBenoit, V., & Gabola, P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182212065 · Cited by 114
Preventing child maltreatment in low- and middle-income countries
Ward, C. L., Sanders, M. R., Gardner, F. E. M., Mikton, C. R., & Dawes, A. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.11.002 · Cited by 74
Langberg, J. M., Dvorsky, M. R., Molitor, S. J., Bourchtein, E., Eddy, L. D., Smith, Z. R., Oddo, L. E., & Eadeh, H.-M. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000265 · Cited by 74
“For example, some adolescents have considerable difficulty focusing during homework completion, make careless mistakes and take significantly longer than expected to complete work (Sibley et al., 2014, 2016).”
BackgroundPromoting Children’s Healthy Habits Through Self-Regulation Via Parenting
Baker, S., Morawska, A., & Mitchell, A. (2019) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-019-00280-6 · Cited by 76
“Parenting interventions have an extensive evidence base in terms of increasing parental self-efficacy and improving child behavior (e.g., Triple P-Positive Parenting Program; Sanders et al. 2014), and some evidence suggests that they improve child self-regulatory capabilities (e.”
BackgroundZemp, M., Milek, A., Cummings, E. M., Cina, A., & Bodenmann, G. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0260-1 · Cited by 76
Community-Level Approaches to Child Maltreatment Prevention
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Osman, F. A., Salari, R., Klingberg‐Allvin, M., Schön, U., & Flacking, R. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017600 · Cited by 73
Using positive psychology interventions to strengthen family happiness: A family systems approach
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González, C., Morawska, A., & Haslam, D. M. (2018) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0259-4 · Cited by 78
“Parenting interventions are effective in promoting positive parenting practices, nurturing parent–child relationships, and reducing coercive parenting and child behaviour problems (Sanders et al. 2014; World Health Organization 2009).”
BackgroundUsing Father Preference Data to Increase Father Engagement in Evidence-Based Parenting Programs
Frank, T. J., Keown, L. J., Dittman, C. K., & Sanders, M. R. (2014) · Journal of Child and Family Studies · doi:10.1007/s10826-014-9904-9 · Cited by 68
Cowan, C. P., & Cowan, P. A. (2018) · Journal of Family Theory & Review · doi:10.1111/jftr.12301 · Cited by 67
What is needed to eradicate the depression epidemic, and why
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The impact of parent-only interventions on child anxiety: A systematic review and meta-analysis
Jewell, C., Wittkowski, A., & Pratt, D. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.082 · Cited by 77
Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2016) · Prevention Science · doi:10.1007/s11121-016-0631-x · Cited by 65
Salari, R., & Filus, A. (2016) · Prevention Science · doi:10.1007/s11121-016-0696-6 · Cited by 65
“More specifically, they are identified as one of the best evidencebased treatments for children and youth with externalizing problems such as disruptive behaviors and ADHD (Evans et al. 2014; Sanders et al. 2014).”
Frank, T. J., Keown, L. J., & Sanders, M. R. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.05.008 · Cited by 64
England-Mason, G., Andrews, K., Atkinson, L. R., & González, A. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102252 · Cited by 75
Family adjustment and interventions in neurodevelopmental disorders
Dykens, E. M. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000129 · Cited by 71
Recent advances in the prevention of mental disorders
Mendelson, T., & Eaton, W. W. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1501-6 · Cited by 69
The role of mindfulness and compassion in enhancing nurturing family environments.
Kirby, J. N. (2016) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12149 · Cited by 69
Strategies for parenting by mothers and fathers with a mental illness
van der Ende, P. C., van Busschbach, J. T., Nicholson, J., Korevaar, E. L., & van Weeghel, J. (2016) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12283 · Cited by 60
Tully, L. A., Collins, D., Piotrowska, P. J., Mairet, K. S., Hawes, D. J., Moul, C., Lenroot, R., Frick, P. J., Anderson, V. A., Kimonis, E. R., et al. (2017) · Child Psychiatry & Human Development · doi:10.1007/s10578-017-0733-0 · Cited by 61
“In addition, repeated assessment at post-intervention is important for determining intervention effectiveness, especially as there is evidence that fathers may benefit less from parenting interventions (in terms of level of change in parenting and child behavior) than mothers [4, 6, 10].”
BackgroundBeelmann, A., Arnold, L. S., & Hercher, J. (2022) · Aggression and Violent Behavior · doi:10.1016/j.avb.2022.101798 · Cited by 66
The Child Maltreatment Prevention Landscape: Where Are We Now, and Where Should We Go?
Harden, B. J., Simons, C., Johnson‐Motoyama, M., & Barth, R. P. (2020) · The Annals of the American Academy of Political and Social Science · doi:10.1177/0002716220978361 · Cited by 57
Elevated attention deficit hyperactivity disorder symptoms in children who stutter
Druker, K., Hennessey, N. W., Mazzucchelli, T. G., & Beilby, J. M. (2018) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2018.11.002 · Cited by 57
The development of violence from age 8 to 61
Farrington, D. P. (2019) · Aggressive Behavior · doi:10.1002/ab.21831 · Cited by 56
Jans, T., Jacob, C., Warnke, A., Zwanzger, U., Groß‐Lesch, S., Matthies, S., Borel, P., Hennighausen, K., Haack‐Dees, B., Rösler, M., et al. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12443 · Cited by 56
Schrank, B., Moran, K. A., Borghi, C., & Priebe, S. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1069-3 · Cited by 56
Toumbourou, J. W., Rowland, B., Williams, J. W., Smith, R., & Patton, G. C. (2019) · Health Psychology · doi:10.1037/hea0000735 · Cited by 55
The First 2,000 Days and Child Skills
Doyle, O. (2019) · Journal of Political Economy · doi:10.1086/705707 · Cited by 72
“and child social, emotional, and behavioral outcomes (Sanders et al. 2014).”
BackgroundLi, N., Peng, J., & Li, Y. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.709851 · Cited by 72
“The level of intervention is a crucial factor in moderating the effect of the intervention (Sanders et al., 2014).”
BackgroundDads Tuning In to Kids: Preliminary Evaluation of a Fathers' Parenting Program
Wilson, K. R., Havighurst, S. S., Kehoe, C. E., & Harley, A. E. (2016) · Family Relations · doi:10.1111/fare.12216 · Cited by 54
Does adding an emotion component enhance the Triple P−Positive Parenting Program?
Salmon, K., Dittman, C. K., Sanders, M. R., Burson, R. A., & Hammington, J. (2014) · Journal of Family Psychology · doi:10.1037/a0035997 · Cited by 53
Kirby, J. N. (2019) · Education Sciences · doi:10.3390/educsci10010003 · Cited by 65
“For example, the Triple P-Positive Parenting Program [26,27], and the Incredible Years Program [28], are two examples of programs that have had a significant impact on parenting practices and reductions in child behavior problems.”
BackgroundThe effectiveness of universal parenting programmes: the CANparent trial
Lindsay, G., & Totsika, V. (2017) · BMC Psychology · doi:10.1186/s40359-017-0204-1 · Cited by 57
“There is now substantial evidence that positive mental health and social development in children is grounded in the quality of parent-child interactions [5, 6] and positive, warm, nurturing environments [7].”
BackgroundWard, H., Brown, R., & Hyde‐Dryden, G. (2014) · Loughborough University Research Repository (Loughborough University) · Cited by 51
Stormshak, E. A., Seeley, J. R., Caruthers, A. S., Cardenas, L. E., Moore, K. J., Tyler, M. S., Fleming, C. M., Gau, J. M., & Danaher, B. G. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000907 · Cited by 50
The Significance of Interparental Conflict for Children
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Averdijk, M., Zirk‐Sadowski, J., Ribeaud, D., & Eisner, M. (2016) · Journal of Experimental Criminology · doi:10.1007/s11292-015-9249-4 · Cited by 60
“A recent meta-analysis conducted by the program developers examined findings from 101 Triple P studies (Sanders et al. 2014) and reported positive effects, mainly based on parent assessments, over a broad range of outcomes, including parenting practices and children’s social, emotional, and behavioral outcomes.”
BackgroundA randomized clinical trial of interventions for improving well-being in custodial grandfamilies.
Smith, G. C., Hayslip, B., Hancock, G. R., Strieder, F. H., & Montoro‐Rodríguez, J. (2018) · Journal of Family Psychology · doi:10.1037/fam0000457 · Cited by 51
Psychosocial Treatment and Prevention of Conduct Problems in Early Childhood
Cornacchio, D., Bry, L. J., Sanchez, A. L., Poznanski, B., & Comer, J. S. (2017) · Wiley eBooks · doi:10.1002/9781119092254.ch26 · Cited by 49
Hails, K. A., Petts, R. A., Hostutler, C. A., Simoni, M., Greene, R. K., Snider, T. C., & Riley, A. R. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105450 · Cited by 49
Metadata
- Authors
- Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Sanders, Matthew R.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 34
- Issue
- 4
- Pages
- 337-357
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2147100455
- Cited by
- 1,077
- References
- 170
- Citations by year
- 2026: 86 · 2025: 98 · 2024: 110 · 2023: 104 · 2022: 83 · 2021: 95 · 2020: 119 · 2019: 94 · 2018: 78 · 2017: 72 · 2016: 83 · 2015: 36 · 2014: 17
- FWCI
- 10.48
- Type
- journal article
- Language
- en
- Update notices
- erratum (2014-12-01)
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- Triple P-Positive Parenting Program, parenting support, child behavior problems, parenting practices, parenting satisfaction, parental adjustment, parent-child relationship, child well-being, family well-being
- MeSH terms
- Adult, Child, Child Behavior Disorders, Female, Humans, Male, Parents, Personal Satisfaction, Social Support, Program Evaluation, Parenting
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