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 for families with complex concerns. Primary Care Triple P is a level 3 intervention, this level focuses on families whose children have mild to moderate behaviour concerns.

Primary Care Triple P is a brief targeted intervention and is aimed at families with children up to 12 years old, where the child has a discrete behaviour or developmental issue which are not complicated by other major behaviour management difficulties or family dysfunction. Practitioners offer 3-4 short (15-30 minute) one-to-one sessions with parents during which they assist parents to develop parenting plans to manage behaviour issues.

Sessions can be done in person, over the phone or a combination of both. Practitioners work from a manual and provide parents with targeted tip sheets and a Positive Parenting Booklet. Practitioners also utilise the Triple P Every Parent’s Survival Guide DVD in sessions. Primary Care Triple P is well operationalised, the manual 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. Primary Care Triple P sessions cover assessment of the presenting problem, developing a parenting plan to target the parent’s specific behaviour concern, reviewing the implementation and setting goals for further refinement of the plan if needed, and finally a follow up session to review goals.

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 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 have 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. 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 two days of training. This is followed by a one day pre-accreditation and a half day accreditation. Prior to the accreditation session practitioners need to complete a quiz and competence preparation. In total, it is estimated that training and accreditation should take 4 – 5 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

All Triple P interventions support parents of children 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 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

The Triple P system has been developed as an early intervention strategy within a preventative framework. Primary Care Triple P is a brief targeted intervention for parents of children up to the age of 12 with mild behaviour difficulties.

• Is taking an early intervention and prevention approach to child behaviour and emotional difficulties a priority for your service?

Existing Initiatives 

• Is the delivery of a brief targeted intervention for parents of child with a discrete behaviour or developmental issue aligned with the priorities of your organisation?
• Does your service already provide early intervention programmes aiming to improve child development and mental health outcomes?

Workforce

One practitioner is required to train and deliver the interventions with families. Triple P UK recommends that in addition to the session time (4 sessions of 15 – 30 minutes) that practitioners have time for session preparation and supervision. They recommend that for one family 2-hour session time is required and 1 ½ hours for preparation and admin per family. Practitioners require time to attend training and accreditation which is estimated to take 4-5 days.

• Do you have staff able to commit time to training and delivery of the intervention?

Technology Support

To implement Primary Case 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?
• Programme delivery can involve families viewing a DVD with the practitioner, do you have the technology available to practitioners to do this?

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?

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 Triple P is for families with children up to 12 years old, where the child has a discrete behaviour or developmental issue which are not complicated by other major behaviour management difficulties or family dysfunction. Evidence of its effectiveness for children age 0-36 months comes from a study that included children 2 – 6 years old. Most children lived in 2 parent households with parents who were in full or part time employment. The study took part in community health clinics in low income areas in an urban area. Parents all reported one or more concerns about their child’s behaviour or their own parenting.

• Is this comparable to the population you serve?

Desired Outcome

Primary Care Triple P in a brief targeted intervention aiming to intervene early with families to avoid challenging behaviours escalating. It aims to assist parents to develop parenting plans to manage behaviour issues, to increase parents’ confidence in their parenting ability and to promote parent’s self-sufficiency in managing future difficulties.

Research found that parents receiving Primary Care Triple P reported fewer problem behaviours following intervention than those who did not receive any intervention. It also found that following Primary Care Triple P mothers reported less dysfunctional parenting strategies, lower anxiety and lower stress than mothers in a control group. 

• Is reducing child behaviour problems, improving parenting practices and reducing stress and anxiety in mothers an aim of your service?