Using Triple P as a Model to Engage Communities and Prevent Child Maltreatment

By Calondra Tibbs, MPH, Senior Director, Safe and Healthy Families, NACCHO

Positive relationships between caregivers and children play an important role in the health and well-being of children throughout their lives. Establishing safe, stable, and nurturing environments and relationships and limiting exposure to adverse experiences (e.g., trauma, abuse, and neglect) can potentially reduce poor health outcomes and behaviors in a child’s adolescent and adult lives.1 The Adverse Childhood Experience (ACE) Study demonstrated that increased exposure to maltreatment can increase risk for alcoholism and alcohol abuse, illicit drug use, liver disease, smoking, unintended pregnancies, and chronic obstructive pulmonary disease.1

NACCHO, with support from the Centers for Disease Control and Prevention (CDC) and the Doris Duke Charitable Foundation (through the CDC Foundation), implemented a multi-year Triple P Implementation Project to learn more about systems interventions to address child maltreatment. The project aimed to understand and learn more about how public health and primary care partnerships could implement Triple P—Positive Parenting Program, an evidence‐based system of interventions that enhances parental knowledge, skills, and confidence to prevent and address behavioral, emotional, and developmental problems in children.

Using the conceptual framework and drivers for program implementation developed by National Implementation Research Network (NIRN), NACCHO evaluated Triple P implementation in two communities to determine the successes, challenges, and opportunities for public health and primary care collaboration to implement the Triple P program. Table 1 provides an overview of the evaluation findings, using the NIRN framework.

Table 1. Summary of Evaluation Findings Using the NIRN Framework

Stage of Implementation Description Evaluation Findings
Exploration Communities assess the match between their needs and the fit of an intervention
  • Needs assessments demonstrated that the communities had a need for parenting support.
  • Triple P was identified as having strong potential to meet the parenting skills-building and support needs of the communities.
Installation Communities acquire resources to prepare for implementation
  • Local health departments (LHDs) can serve as the catalyst for implementation of Triple P.
  • Development of strong partnerships between the LHD and Federally Qualified Health Center was a challenge at both sites.
  • All key partners were not identified during installation; new partners were engaged throughout implementation.
  • Communities and agencies should develop implementation plans to integrate Triple P into program services prior to training agency staff.
Initial Implementation Organizations begin to adapt new practice, manage change, and initiate improvement
  • Communities successfully implemented various levels of Triple P.
  • Communities experienced challenges with practical technical assistance to implement Triple P within diverse agencies.
  • Data collection and reporting was a challenge through the multi-agency collaborative.
  • Agencies with provider and services flexibility were more likely to implement Triple P services.
  • Reimbursement for services hindered Triple P integration into primary care setting.
  • Triple P implementation was enhanced in communities with state-level support and resources.
Full Implementation The intervention is fully operational, and 50% or more of the intended practitioners are using Triple P with fidelity.
  • Communities had not reached full implementation at the time of this post.

Triple P is a promising evidence-based parenting support strategy that both providers and parents find appealing. LHDs have the connections to mobilize partners to implement a community-wide initiative. As this project shows, LHDs, or likely any agency, may face significant challenges when implementing this model. Implementing evidence-based practices on a community-wide basis requires considerable time and the support of multiple entities at various levels. This evaluation provides some lessons from one such attempt that can inform future efforts at implementing Triple P and other evidence-based practices.

For more information about the Triple P Implementation Project, read NACCHO’s report, Local Health Department Implementation of Triple P: Experiences of Berrien County, Michigan, and Pitt County, North Carolina.

Additonal NACCHO Resources

Local Health Department Efforts to Prevent Child Maltreatment report –

Public Health Efforts to Prevent Child Maltreatment webinar –


  1. Centers for Disease Control and Prevention. Adverse Childhood Experiences (ACE) Study: Major Findings. Retrieved June 1, 2015, from

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