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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Group Triple P is a level 4 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. 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. Group Triple P is a level 4 intervention, programmes at this level offer intensive targeted support to parents of children who are identified as having moderate/severe behaviour difficulties. Programmes at this level can also be offered at a universal level targeting a specific population, for example low-income areas.
Group Triple P is aimed at families with children up to 12 years old, where parents have concerns about their child’s behaviour. Difficulties may range from demanding, disobedient, defiant, aggressive or generally disruptive behaviours. The aim of the intervention is to prevent the progression of problem behaviours and severe impairment.
The programme is typically facilitated by one practitioner (supported by a second in the early stages of implementation if required) over 8 weeks, with 4 weekly 2 hour group sessions, followed by 3 individual weekly telephone calls of 15 – 30 minutes in length and one final group session. Group Triple P employs an active skills training process to help parents acquire new knowledge and skills. Parents learn through observations, discussions, practice and feedback. Segments from Every Parent’s Survival Guide DVD are used to demonstrate positive parenting skills. Between sessions, parent’s complete homework tasks to consolidate their learning from the group sessions. The 4 initial group sessions cover an introduction to positive parenting, strategies to help children develop positive behaviours and relationships, strategies to manage misbehaviour and planning for high risk situations. During the 3 telephone sessions practitioners support parents to review the implementation of their plan and make any necessary refinements to their plans and goals. Parents come together for one final group session where they review their progress and plan for the future.
Group 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 for all the programmes delivered in-person:
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 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 at an additional cost.
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
Group Triple P practitioners are required to attend three 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 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.
Infants and Toddlers: 0-36 months - Rating: 5
Research Design & Number of Studies
One external Randomised Control Trial (RCT) (Heinrichs et al, 2014), one RCT (Tully & Hunt, 2017) and one quasi-experimental study (Zubrik et al, 2005) conducted by the developer were identified. These studies all included children between 0-36 months within a broader sample, but specific data for this age group is not given. Participants were parents of children 2- 6-years old.
Outcomes Achieved
Child Outcomes
• Significant improvement in child behaviour (Heinrichs et al, 2014; Tully & Hunt, 2017 & Zubrik et al, 2005) maintained at 24 months (Zubrik et al, 2005)
Parent Outcomes
• Significant decline in dysfunctional parenting behaviour (Tully & Hunt, 2017), outcomes maintained at 24-month follow-up (Zubrick et al, 2005) and 4-year follow-up (Heinrichs et al, 2014)
Key References
Tully, L. & Hunt, C. (2017) A Randomized Controlled Trial of a Brief Versus Standard Group Parenting Program for Toddler Aggression. Aggressive Behavior, 43: 291-303
Heinrichs, N., Kliem, S., & Hahlweg, K. (2014) Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes. Prevention Science, 15: 233-245
Zubrik et al (2005) Prevention of Child Behavior Problems Through Universal Implementation of a Group Behavioral Family Intervention Prevention Science, 6: 287-304
Preschool: 3 to 5 years - Rating: 5
Research Design & Number of Studies
The best available evidence for Group Triple P for children 3-5 years is drawn from one external randomised control trial (RCT) (Heinrichs et al, 2014) ; and one RCT (Tully & Hunt, 2017) and one quasi-experimental study (Zubrik et al, 2005), which were conducted by the developer. Participants were parents of children 2-6-years old. Evidence outcomes for the age range 3-5 years old are the same as for the 0-36 month evidence above.
Primary school: 6 to 12 years - Rating: 4
Research Design & Number of Studies
The best available evidence for Group Triple P for children 6-12 years is drawn from two internal randomised control trial (RCTs). Heinrichs et al (2014) included children aged 2.6-6 years and was conducted by programme developer and researchers working for programme licence owner. Separate data were not reported for children aged 6 years. Guo et al study (2016) included children in the first three years at school (mean age 8.05 years), and was conducted by researchers who are members of the International Scientific Advisory Committee for Triple P.
Outcomes Achieved
Compared to control group, Triple P Group was associated with:
Child Outcomes
• Significant immediate improvement in child behaviour problems (Heinrichs et al, 2014)
• Significant reduction in child adjustment problems post-intervention, and maintained at 6 months follow-up (Guo et al., 2016)
Parent Outcomes
• Significant improvement in parenting practices, parental adjustment problems, and parenting confidence at post-intervention, and maintained at 6 months follow-up (Guo et al., 2016)
• Significant decline in dysfunctional parenting behaviour which was maintained at 4 years follow-up (Heinrichs et al, 2014)
References
Guo, M., Morawska, A. and Sanders, M.R., 2016. A randomized controlled trial of group triple P with Chinese parents in Mainland China. Behavior modification , 40 (6), pp.825-851.
Heinrichs, N., Kliem, S., & Hahlweg, K. (2014) Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes. Prevention Science , 15: 233-245
Need
Comparable Population
Group Triple P is an intensive targeted support for parents of children who are identified as having moderate / severe behaviour difficulties and parents who are interested in promoting their child’s development.
Research showing the effectiveness of Group Triple P included children from a range of socioeconomic backgrounds and a range of countries and cultures. Most participants were from 2 parent families who were university educated. One study was conducted in the context of regular health service delivery in an area a where a high proportion of families were in receipt of Family Crisis Program benefits and where there were higher rates of child abuse notifications.
Is this comparable to the population you serve? Desired Outcome
The aim of the intervention is to prevent the progression of problem behaviour and severe impairment. Group Triple P has been found to be effective in reducing child problem behaviour including aggression and in reducing dysfunctional parenting strategies. It has also been found to be effective in reducing parent reported depression, anxiety and stress, conflict over child rearing and increasing parenting self-efficacy.
Is reducing child behaviour problems, improving parenting practices and parental self-efficacy and improving parental well-being an aim of your service?
Need Score
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Fit
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
Group Triple P is a targeted intensive intervention for parents of children up to the age of 12 with moderate / severe behaviour difficulties.
Is taking a targeted approach to child behaviour and emotional difficulties a priority for your service? Existing Initiatives
Does your service already provide targeted parent group intervention programmes aiming to prevent the progression of problem behaviours and severe impairment. Does your service already provide targeted intensive intervention programmes aiming to improve child development and mental health outcomes?
Fit Score
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Capacity
Workforce
Group Triple P practitioners require time to attend the training and for group delivery. Training and accreditation should take 6 days of practitioner time. Triple P UK estimate that group sessions and telephone calls should take 25 hours over 8 weeks, with an additional 15 hours over the 8 weeks for scoring questionnaires, session preparation and debriefing and case notes / report writing. They estimate that to deliver a group it should take about 40 hours of practitioner time.
Triple P UK recommends that for all programmes 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? Do you have appropriate staff with the capacity to train and deliver this intervention?
Technology Support
To implement Group 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 you have enough administrative capacity and systems to meet these administrative needs? Do you have access to facilities to host Group Triple P?
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?
Capacity Score
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