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Triple P—Positive Parenting Program (System)

Public Health & Prevention: Population-level policies
Benefit-cost methods last updated December 2024.  Literature review updated June 2020.
Triple P—Positive Parenting Program (System) is a universal prevention program that aims to increase the skills and confidence of parents to prevent and treat severe behavioral and emotional problems in their children. Triple P engages parents and children in programming that aims to improve long-term outcomes.
Triple P has five levels of intensity. The first level is a media campaign that aims to increase awareness of parenting resources, de-stigmatize help-seeking, and inform parents about solutions to common behavioral problems. Levels two and three are primary health care interventions for children with mild behavioral difficulties. In contrast, levels four and five are more intensive individual- or class-based parenting programs for families of children with more challenging behavior problems. Triple P targets children up to 12 years old and provides approximately 24 months of intervention.
Evaluations included in the analysis of Triple P (System) are population-based trials that provide all levels (1-5) of the Triple P program to families. Evaluations limited to particular levels of Triple P (i.e., Triple P—Positive Parenting Program: Level 4, individual or Triple P—Positive Parenting Program: Level 4, group) are excluded from the analysis and analyzed separately.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2023).  The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $1,024 Benefits minus costs $2,789
Participants $1,905 Benefit to cost ratio $8.87
Others $211 Chance the program will produce
Indirect $4 benefits greater than the costs 71%
Total benefits $3,143
Net program cost ($355)
Benefits minus cost $2,789

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Child abuse and neglect
Substantiated or founded reports to child protective services.
 4 1 95686 -0.077 0.118 5 -0.077 0.118 17 -0.214 0.093
Out-of-home placement
The removal of a child from parental care, most often to foster care.
 4 1 95686 -0.047 0.141 5 -0.047 0.141 17 -0.132 0.361
Externalizing behavior symptoms
Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.
 4 1 3022 -0.048 0.026 6 -0.026 0.019 9 -0.048 0.068
Internalizing symptoms
Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.
 4 1 3022 -0.059 0.026 6 -0.059 0.026 8 -0.059 0.023
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Child abuse and neglect Criminal justice system $53 $0 $106 $27 $186
Child abuse and neglect $30 $310 $0 $15 $355
K-12 grade repetition $8 $0 $0 $4 $12
K-12 special education $133 $0 $0 $67 $200
Property loss associated with alcohol abuse or dependence $0 $0 $0 $0 $0
Labor market earnings associated with child abuse & neglect $665 $1,566 $0 $0 $2,230
Mortality associated with child abuse and neglect $0 $0 $0 $2 $2
Out-of-home placement Out-of-home placement $33 $0 $0 $17 $50
Externalizing behavior symptoms Health care associated with externalizing behavior symptoms $101 $29 $105 $51 $286
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($177) ($177)
Totals $1,024 $1,905 $211 $4 $3,143
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $139 2011 Present value of net program costs (in 2023 dollars) ($355)
Comparison costs $0 2011 Cost range (+ or -) 50%
To calculate per-participant costs for Triple P (System) we first use the training costs for levels 2 through 5 summed from Foster, E.M., Prinz, R.J., Sanders, M.R., & Shapiro, C.J. (2008). The costs of public health infrastructure for delivering parenting and family support. Children and Youth Services Review, 30(5), 493-501. We then use the population information from the program evaluations to estimate the cost per child in the community. Level 4 and 5 parenting program costs resulted by multiplying the average Washington cost per family (provided by Kimberlee Shoecraft, WA Department of Social and Health Services, personal communication, April 2012) by the portion of the population assumed to receive the parenting program (approximately 10% of participants).
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12.