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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
Standard 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 or families with complex concerns.
Standard Triple P is for parents or caregivers of a child up to 12 years old where they have concerns about the child’s behaviour. The aim of the intervention is to prevent the progression of problem behaviours and severe impairment. The intervention is delivered individually to families over 10 sessions (40-60 minutes each). Sessions take place in clinic or the family home.
The intervention comprises of two assessment sessions, two sessions on positive parenting skills, three practice sessions, two sessions of planned activities training and a closure session. During sessions practitioners use active skills training methods including modelling, rehearsal, feedback and homework tasks. Segments from Every Parent’s Survival Guide DVD may be used to demonstrate positive parenting skills.
Standard 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 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 video clips 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
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. 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.
Evidence - Rating: 1+ - 4
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: 1+
Research Design & Number of Studies
No research was identified that indicated the effectiveness of the Standard Triple P intervention, for parents of children up to 36 months old.
Preschool: 3 to 5 years - Rating: 4
Research Design & Number of Studies
The best evidence for children aged 3 -5 years old comes from a quasi-experimental study conducted by the programme developer (Sanders et al., 2000; 2007). Participants were parents of 3 year old children, where there was parental concern about child behaviour, and family adversity. Families were randomly allocated to either one of three Triple P interventions, including Standard Triple P (n=77) or waitlist control.
Outcomes Achieved
In comparison to waiting list control, participation in Standard Triple P was associated with:
Child Outcomes
• Significantly less observed negative child behaviour.
• Significantly less parent-reported negative child behaviour.
Parent Outcomes
• Significant reduction in parent-reported use of dysfunctional discipline strategies.
• Significant increase in mother-reported parental competence.
The gains made at post intervention were maintained at 12 month, and 3 year follow up. However, there was not a control group for the follow-up periods.
References
Sanders, M., Bor, W., & Morawska, A. (2007) Maintenance of Treatment Gains: A Comparison of Enhanced, Standard, and Self-directed Triple P-Positive Parenting Program. Journal of Abnormal Child Psychology. 35:983-998
Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The triple P-positive parenting program: a comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of consulting and clinical psychology , 68 (4), 624.
Primary school: 6 to 12 years - Rating: 1+
Research Design & Number of Studies
There is no available evidence for the effectiveness of this programme for the 6-12 years age group.
Need
Comparable Population
Standard Triple P is an intensive targeted intervention for parents of children who are identified as having moderate / severe behaviour difficulties. Difficulties may range from demanding, disobedient, defiant, aggressive or generally disruptive behaviours.
Is this comparable to the population you serve? Desired Outcome
Standard Triple P is an intensive targeted intervention, focusing on supporting families with severe behaviour difficulties. The aim of the intervention is to prevent the progression of problem behaviour and severe impairment.
Is reducing child behaviour problems and improving parenting practices 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
Standard 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 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
A minimum of one practitioner is required to deliver the Standard Triple P intervention. Practitioners require time to attend the training and for delivery of the 10-week programme. Training and accreditation should take six days of practitioner time. In addition to the ten hours to takes to deliver the intervention, it is recommended by Triple P UK that time is dedicated to scoring assessments and preparing sessions as well as time for debriefing, note keeping / report writing and supervision. Totalling an additional nine hours per intervention.
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 Standard 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?
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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