Parent-child relationships unquestionably play a prominent role in the development and biopsychosocial wellbeing of children (Sanders, Markie-Dadds & Turner, 2003). Social learning models demonstrate the "reciprocal and bidirectional" character of these relationships (Patterson, 1982; Sanders, 1999), and emphasise how breakdown in personal or interpersonal aspects can result in suboptimal child development and negative mental health outcomes. Risk factors for major behavioural and emotional concerns in children (e.g. antisocial disorders, juvenile crime, drug and alcohol abuse) eminently include many inadequacies in the parent-child relationship: rigid and disproportionate discipline; insufficient supervision and investment; and absence of warm, positive connections and secure attachments with parents (Sanders, Markie-Dadds & Turner, 2003). In addition to these interpersonal concerns, research in developmental psychopathology highlights parent-level risk factors, notably: poor self-regulation and parent distress (depression, anger, anxiety and stress) (Sanders, Markie-Dadds, & Turner, 1999; Sanders, Markie-Dadds & Turner, 2003), and marital conflict (Grych & Fincham, 1990; Rutter, 1985; Sanders, Markie-Dadds & Turner, 2003).
In the absence of adequately-tailored parenting education, many parents typically receive little or no instruction in parenting skills, and base parenting choices on habituation from their own childhood experiences (Sanders, Markie-Dadds, Tully & Bor, 2000). Family relationships may reach a reversible state of vulnerability where current skills lack sufficient complexity to meet present parenting demand. From a social cognitive perspective (Bandura, 1977) this vulnerability can generate and reinforce negative self-efficacy toward parenting, and a state of learned helplessness (Donovan, Leavitt, & Walsh, 1990) or demoralisation (Webster-Stratton & Herbert, 1994). Moreover, unfamiliarity with the range of adaptive parenting choices may reinforce dysfunctional cognitions and false attributions about the source, locus of control, and nature of presenting problems (e.g. genetics, issues inherent in the child) (Sanders, Pidgeon, Gravestock, Connors, & Young, 2003). Parents may also not be aware of the role of unexplored mood reactions in cases where distressing parental mood is indicated in the clinical picture (Sanders, Markie-Dadds, & Turner, 1999). Further, at the social systems level, stigmatisation of family problems and seeking specific mental health assistance can lead to unfortunate delay in seeking intervention (Webster-Stratton & Herbert, 1994; Sanders, Markie-Dadds & Turner, 2003). These associations together suggest a role for multifaceted and integrated parental support interventions in preventing and managing antecedent risk factors for child development.
Both educational and therapeutic interventions can support parents in reaching and maintaining self-defined goals for positive parenting competence – both in terms of active skill acquisition and management of cognitive, behavioral and mood concerns (Sanders, Markie-Dadds & Turner, 2003).
The evidenced-based Triple-P Positive Parenting Program includes cognitive-behavioural methods in its structured suite of multi-level educational and psychosocial family interventions (Sanders, Markie-Dadds & Turner, 2003). In a number of randomised controlled trials, Triple-P's tiered-blend of compassionate support, goal-directed education and active skills training for variant severities of child problems, has demonstrated effectiveness in both management of extant child behavioural and emotional concerns, and early-intervention/prevention (Sanders, Markie-Dadds & Turner, 2003). Central to this approach is development and maintenance of positive parental competence, typified by: (1) establishing adequate and independently-enacted self-regulatory processes capable of flexible deployment across a range of life contexts (e.g. home, shopping) (Sanders, Markie-Dadds & Turner, 2003; Karoly, 1993); together with (2) an orientation toward five core principles of positive parenting which address the specific risk and protective factors for child development and mental health mentioned above (Sanders, Markie-Dadds & Turner, 2003). These factors include: teaching parents how to create a safe, engaging, positive and comprehensible learning environments (Hart & Risley 1975; Risley, Clark, & Cataldo, 1976), replacement of coercive discipline with assertive practice (Sanders & Dadds, 1993), reorganisation of child expectations against realistic capabilities (Azar & Rohrbeck, 1986), and committing to personal self-care and wellbeing (Sanders, Markie-Dadds & Turner, 2003).
Stimulating competence in the core still of self-regulation addresses issues of self-efficacy by co-creating new positive options for parents, which in-turn reinforce an internal locus of control and capacity for effective personal agency in family matters (Sanders, Markie-Dadds & Turner, 1999). Self-sufficiency is also encouraged by Triple-'s co-creative cognitive behavioral intervention process in which professionals facilitate parents in setting their own self-determined goals, standards, performance criteria, evaluation, monitoring and change strategies (Sanders, Markie-Dadds & Turner, 2000). This approach also effectively works within public health resource limitations, by providing parents with minimally sufficient guidance, feedback and compassionate support from health professionals while also providing a broader media-resource and self-directed learning strategy (Sanders, Markie-Dadds & Turner, 2000). Cognitive-behavioural strategies for guided self-directed learning and homework are a key feature of Triple-P's educational component, and involve provision of accessible plain-language written, audio and visual media illustrating key prevention and management approaches to common problems and risk factors (Sanders, Markie-Dadds & Turner, 2003).
Randomised controlled effectiveness trials have repeatedly demonstrated significant decreases in disruptive child behaviour, dysfunctional parenting and parenting conflict, and higher levels of parenting efficacy, satisfaction, and relationship satisfaction, after Triple-P intervention (e.g. Sanders and McFarland, 2000; Sanders, Markie- Dadds, Tully and Bor, 2000). Importantly, these results have been achieved in both therapist-supported, group-directed and self-directed formats (Sanders, Markie-Dadds & Turner, 2003; Leung, Sanders, Leung, Mak, and Lau, 2003; Ireland, Sanders and Markie-Dadds, 2003; Bor, Sanders and Markie-Dadds, 2002). Moreover, participant satisfaction has been evidenced for a range of levels and different structures of the program (Sanders, Markie-Dadds & Turner, 2003).
To this end, it is proposed that the tiered, multifaceted Triple-P approach represents a comprehensive, adaptable, responsive, preventatively-oriented, publicly accessible, affordable, and evidence-based parental support strategy for management and prevention of risk factors leading to child development and mental health issues.
