Core Components

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. 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.

Stepping Stones Triple P forms part of the Triple P – Positive Parenting Program® system and includes adaptations for children who have a disability. Primary Care Stepping Stones Triple P is a Level 3 one-to-one intervention for parents who may be unable to commit to regular treatment over longer period of time, who have a specific concern about their child’s behaviour. The programme focuses on families with children who have a disability with discrete problem behaviours or developmental skill delays such as social skills or communication. Practitioners offer 2-4 (15-30 mins) sessions, the first two sessions are conducted in person, the remainder either in person or by telephone. During these sessions parents are assisted in developing parenting / behaviour support plans and taught skills including managing misbehaviour.

Primary Care Stepping Stones Triple P is well operationalised, each practitioner receives a facilitator’s manual that provides comprehensive guidance around what should be covered in each session. It also gives clear guidance about which strategies are recommended across the different ages.  Parents receive a workbook, which describes the information and strategies presented during the sessions and includes homework tasks.

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.

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 are now available 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. 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 any additional implementation support 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.

Triple P UK note that professionals who usually undertake the course are those who may be involved in support for the client and are able to provide focused therapeutic interventions, including teachers, school counsellors, nurses, health visitors, family physicians and allied health professionals. Triple P UK 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 attend three days of training. This is followed by a one day pre-accreditation and a half day accreditation day. Prior to the accreditation session practitioners need to complete a quiz and competency preparation. In total it is estimated that training and accreditation should take six 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 theory.

Values

Primary Care Stepping Stones Triple P interventions support parents of children with a disability who have, or are at risk of developing, behaviour problems. The 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 emotions problems.

Triple P takes a minimal sufficiency approach, offering families just the amount of support parents requires 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 with a developmental disability 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

The Stepping Stones Triple P system has been developed as an early intervention strategy within a preventative framework for parents of children up to the age of 12 with a developmental disability targeting discrete problem behaviours or development skills.

• Is taking an early intervention and prevention approach to children with a developmental disability with discrete problem behaviours or development skill delays a priority for your organisation?

Existing Initiatives 

• Does your service already provide early intervention programmes for parents of children with a developmental disability who have or are at risk of developing difficult behaviours?
• Does your service, or a locally accessible service, provide this intervention or plan to implement Level 3 interventions?

Workforce

One practitioner is required to deliver a Primary Care Stepping Stones programme.  Practitioners require time to deliver the intervention, between 30 minutes to 2 hours (2-4 sessions of 15–30 minutes), as well as preparation, administration and supervision time. Triple P UK recommends that practitioner have a post-high school qualification in health, education, child care, or social services, but there are no pre-requisites to access training. Training takes place over three days, followed by a one day pre-accreditation and a half-day accreditation. 

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

Technology Support

To implement Primary Care Stepping Stones 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 access to adequate technology to support practitioners to effectively deliver the technological components of the programme?
• 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 your current administrative procedures support your practitioners to implement a programme like this?
• Do you have access to facilities to host Primary Care Stepping Stones Triple P sessions?

Financial Support

Costs can be provided directly from Triple P UK for training groups of staff from 12–20 practitioners. In addition to training, the costs of programme resources and 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 

Primary Care Stepping Stones Triple P is for families with children up to 12 years old with a developmental disability targeting discrete problem behaviours or development skills. 

Evidence of its effectiveness includes white children predominantly male, between 2 and 9 years with Autism Spectrum Disorder.     

• Is this an identified population of concern to your organisation?
• Is this comparable to the population you serve?

Desired Outcome

Primary Care Stepping Stones Triple P is a one-to-one intervention aimed at families with children who have a developmental disability up to 12 years old and is designed to target discrete problems behaviours or developmental skills.

Research has identified that parents participating in Primary Care Stepping Stones Triple P had significant short-term improvements in parent reported child behaviour problems, dysfunctional parenting styles, parenting confidence and parental stress and parental conflict and relationship happiness.

• Are the improvements of parenting practices and children’s behaviour a priority outcome for your organisation?
• Is supporting parents to develop skills to resolve conflicts and cope positively with stress a priority for your service?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?