Core Components

Enhanced Triple P is a Level 5 intervention from the multi-level Triple P System. The Triple P – Positive Parenting Program® is a parenting and family support system designed to prevent and treat behaviour and emotional problems in children and teenagers. All programmes in the system take a self-regulatory approach that encourages practitioners, parents and children to promote independent problem solving. The system takes a minimal sufficiency approach, offering families just the amount of support they require. It also takes a self-regulatory approach that encourages practitioners, parents and children to promote independent problem solving.

The Triple P System has five levels of intervention, each increasing in intensity and directed towards a different level of family need or dysfunction. The levels range from level 1 which takes a universal approach, to level 5 interventions which include programmes which offer intensive family support or families with complex concerns.

Enhanced Triple P is one of the Level 5 interventions and is targeted towards parents of children with behaviour problems as well as parent adjustment difficulties. These might be difficulties such as stress, poor coping, partner conflict or depression. Parents must have completed a Level 4 programme before engaging in the Enhanced intervention. They may benefit from Enhanced Triple P if they have shown minimal improvements on a level 4 programme.

Enhanced Triple P consists of an initial review interview, 3 modules targeting specific concerns which may be offered to families individually or in combination, and a closure session. Each module is between 1 – 3 sessions, therefore the intervention is usually delivered to parents over 3 – 8 (40 – 90 minute) sessions.

The three modules available to work through are Module 1 which is Practice Session where the practitioner and family review and apply level 4 intervention strategies. Module 2 is Coping Skills where parents can learn a range of cognitive and behavioural strategies to manage their mood and cope with stressful situations. Module 3 is Partner Support during which parents learn about positive communication, problem solving, and conflict resolution skills to enhance their teamwork as parenting partners. The intervention ends with maintenance and closure sessions. This is where parents can practise skills and discuss how to maintain changes. They also review their progress and set goals for the future. Practitioners work from a manual and provide parents with an Every Parent Supplementary Workbook for the relevant modules. Enhanced Triple P is well operationalised; the manual provides comprehensive guidance around what should be covered in each session.

Fidelity

Triple P – Positive Parenting Program® has three main fidelity checks / quality assurance strategies across all the programmes:

• Accreditation of practitioners undertaken as part of a provider training course. Intended to establish a baseline of competence for all practitioners.
• Session Checklists are provided for every session in the programme manual.
• Peer Support Networks – Triple P has a Peer Assisted Supervision and Support (PASS) model which is a self-regulatory framework for practitioners where they can support each other’s skills development. The PASS model is covered in the training days.

Modifiable Components

Triple P practitioners can tailor the intervention to meet the needs of individual parents, while maintaining adherence to the overall principles and content of the programmes. Appropriate adaptions are covered during training. In Enhanced Triple P families negotiate with practitioners which modules would be the most appropriate support for them. Modules offered and exercises covered in the modules is based on family report and clinical judgement of the practitioner. Module 3 – Partner Support - is designed for two parent families but for single parent families this module can be adapted to incorporate social support, where two carers such as a family member or friend are involved in the intervention.

Training in Triple P has been delivered in 30 countries and written and audio-visual materials have been translated from English, dubbed or subtitled into 21 languages, with videoclips and workbooks including images of diverse ethnicities. Practitioners can tailor the intervention so it is culturally acceptable, such as using culturally-familiar terminology and examples.

Triple P consultants can offer support to implementing services to consider appropriate adaptions.

 

Triple P – Positive Parenting Program® was developed in Queensland, Australia. Training and implementation has been delivered across 30 countries. Within the United Kingdom training and implementation support can be accessed from Triple P UK.

Support for Organisation/Practice

Implementation Support

Triple P UK has structured implementation supports available to sites. All implementation supports are flexible and tailored to the site’s requirements and are available for all programmes in the Triple P system. Triple P have developed a framework for implementation, it has five phases and are all described in detail in the Triple P Implementation Framework (TPIF). Triple P UK also has Implementation Consultants (IC) available to support new sites work through the phases of implementation.  The five phases of implementation are detailed below:

• Engagement – ICs share information about the Triple P system and work with key contacts to establish if there is a potential fit.
• Commitment and Contracting – ICs work with the organisation to help establish more detailed plans and goals, choose suitable Triple P programme variants, set up implementation support and communications strategies, and together agree on mutual commitments.
• Implementation Planning – ICs help support development of detailed plans for service delivery, communications, training and accreditation, and evaluation for the organisation’s outcomes, based on their readiness and capacity.
• Training and Accreditation – ICs work with key contacts to ensure there are enough trained practitioners to offer the planned Triple P services. This includes ensuring practitioners are prepared for training, have a high-quality experience of training, and have time after training to work on their skills and prepare for and complete their accreditation.
• Implementation and Maintenance – The goal of this phase is to ensure that Triple P is effectively delivered, that there is an active evaluation process from which feedback is provided to practitioners and leadership, that practitioners are getting the most out of Triple P peer support networks, and strategies are in place to support sustainable, effective delivery.

After training, practitioners can access the Triple P Provider Network which has resources such as questionnaires and monitoring forms, further information for learning and development of competencies and access to the Automatic Scoring and Reporting Application (ASRA). Using the ASRA tool, sites can score questionnaires, analyse and compare individual cases and outcomes, enabling reporting and evaluation of the programme’s effectiveness. Additional implementation support options are available from Triple P UK at an additional cost.

Additional implementation support options are available from Triple P UK. These include:

• Triple P Briefing
• Support to Managers and Coordinators
• Strategic Project Consultation
• Support for Practitioners

Licence Requirements

No licence is required.

Start-up Costs

Costs can be provided directly from Triple P UK for training groups of staff from 12–20 practitioners or individual open enrolment training.

Costs that need to be considered are the training course, programme resources for working with parents and children, and any additional implementation supports required. Certain locations will require additional costs of trainer travel and accommodation.

Building Staff Competency

Qualifications Required

Triple P UK recommends that for all programmes practitioners have a post-high school qualification in health, education, early childhood education, or social services. However, para-professionals who actively work with families may also be suitable for training. For training in Enhanced Triple P practitioners must have completed a Level 4 Triple P Provider Training Course and passed their accreditation. Triple P notes that some training in Cognitive Behavioural Therapy (CBT) strategies is an advantage.

Triple P UK note that professionals who usually undertake their Triple P courses are those who may be involved in occasional support for the client and are able to provide focused therapeutic interventions, including teachers, school counsellors, nurse, health visitors, family physicians and allied health professionals. Triple P suggest that the intervention is carried out by a professional in the course of providing routine care for families.

Training Requirements

Practitioners are required to have attended and be accredited in a Triple P Level 4 programmes. In addition they need to attend 2 days of Enhanced Triple P training. This is followed by a 1-day pre-accreditation workshop and a ½ day accreditation. Prior to the accreditation session practitioners need to complete a quiz and competency preparation. It is estimated that Enhanced Triple P training and accreditation should take 3 – 4 days of practitioner time.

Organisations can host agency training at a time and location convenient to them or alternatively individual practitioners can apply for open enrolment training held remotely (video conference) through the UK open enrolment timetable.

Supervision Requirements

No official supervision requirements are detailed by Triple P UK. However, they do have a professional development and peer support model; Peer Assisted Supervision and Support (PASS). This approach brings together Triple P practitioners to support one another to strengthen and refine their Triple P delivery.

 

Theory of Change

The Triple P system aims to enhance family protective factors and reduce risk factors associated with severe behavioural and emotional problems later in childhood. Triple P interventions are based on social learning, cognitive behavioural and developmental theories. The Enhanced programme uses problem solving strategies and cognitive conceptualisation to help parents learn to have supportive, positive, problem solving discussions regarding parenting, as well as developing coping strategies for stressful situations and strong emotions, such as relaxation, identifying unhelpful cognitions and coping self-statements.

Values

Triple P interventions aim to promote positive caring relationships between parents and their children and to help parents develop effective management strategies for dealing with behaviour and emotion problems. 

Triple P takes a minimal sufficiency approach, offering families just the amount of support parents require to resolve a problem and enable parents to be confident, competent and independent in their parenting. It also takes a self-regulatory approach that encourages practitioners, parents and children to promote independent problem solving.

• Is working with families to promote a positive caring relationship with their child match with your service values?
• Does taking a minimal sufficiency approach to offering support align with your service values?

Priorities

Enhanced Triple P is designed to be an intensive family support for families with complex concerns and who have ongoing difficulties with their child’s behaviour following a level 4 intervention. 

• Does this fit with the priorities of your service?

Existing Initiatives

• Does your service already provide intensive family support for families with complex concerns and child behaviour problems?

Families accessing Enhanced Triple P should have completed a level 4 Triple P intervention first.

• Does your service provide this intervention or plan to implement Level 4 interventions?

Workforce

Enhanced Triple P practitioners require time to attend training, deliver the intervention (usually between 3 – 8 weekly sessions of 60-90 minutes), as well as preparation, administration and supervision time. It is estimated that Enhanced Triple P training and accreditation should take 3 – 4 days of practitioner time. Practitioners must have previously completed training and accreditation in a Level 4 Triple P Provider Training Course. 

Triple P UK recommend that practitioners have a post-high school qualification in health, education, early childhood education, or social services.

• Do you have the required staff numbers to meet the need of the demand in your service / area?
• Will staff have the capacity to deliver this intervention?
• Do you appropriately qualified staff available to train and deliver this intervention?

Technology Support

To implement Enhanced Triple P, a computer/data projector and screen is required to show the presentation and video clips (available for practitioners to download or access online).

• Do you have the technology to support practitioners to download, print and photocopy the materials they need to deliver the programme?

Administrative Support

Administrative support is required to collect evaluation data and feedback, print off materials along with co-ordinating and booking of venues.

• Do you have enough administrative capacity and systems to meet these administrative needs?

Financial Support

Costs can be provided directly from Triple P UK for training groups of staff from 10–20 practitioners. In addition to training, the costs of programme resources, any additional implementation supports need to be taken into consideration.

• Do you have the finances available to support the training and implementation of this programme?

Comparable Population 

Enhanced Triple P is aimed at families with a child who are having difficulties with parenting and child behaviour as well as marital conflict and/or parental adjustment difficulties. Families that the intervention is intended for are usually those who are experiencing stress, poor coping and/or parental conflict. Families must have completed a Level 4 Triple P programme and still be experiencing challenges with their child’s behaviour to be eligible for Enhanced Triple P. 

• Are families who experience challenging behaviour from their children concurrently with parental conflict, stress or poor coping an identified population of concern to your organisation?

Desired Outcome

Triple P programmes aim to prevent and treat behaviour and emotional problems in children. Enhanced Triple P aims to help parents learn to have supportive, positive, problem solving discussions regarding parenting, as well as developing coping strategies for stressful situations and strong emotions.

• Are the improvements of parenting practices and children’s behaviour a priority outcome for your organisation?
• Is supporting parents to parent cooperatively, improve their coping skills and stress management skills a priority for your service?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?