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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
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.
Pathways Triple P is a level 5 adjunctive targeted intervention, focused on providing intensive support for families with complex concerns. Attendance at level 3 Primary Care Triple P, Primary Care Stepping Stones Triple P or Primary Care Teen Triple P sessions, or level 4 Triple P sessions (such as Group or Standard Triple P) is a pre-requisite for parents to participate in the Pathways programme. Practitioners offer between two to five individual or group sessions (60-90 minutes each), delivered in a variety of settings including the family home, clinic or a community centre. During these sessions, parents learn how to develop appropriate expectations of their child’s behaviour, manage their own behaviour including anger management, and manage unwanted child behaviour. Pathways Triple P aims to improve children’s mental health and wellbeing and prevent child maltreatment.
Pathways 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 Pathways to Positive Parenting Module 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 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 Automated 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
Practitioners are required to attend two days of training in person. This is followed by a one-day pre-accreditation and a half-day accreditation workshop. 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 4 ½ days of practitioner time.
Training in Pathways Triple P is available as an adjunct to level 3 Primary Care Triple P, Primary Care Stepping Stones Triple P, Primary Care Teen Triple P, or any level 4 Triple P programmes, with training in any of these programmes a pre-requisite to participate.
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: 3
Research Design & Number of Studies
The best available evidence for children aged 0-36 months comes from one Randomised Controlled Trial (RCT), conducted internally by the programme developer. This study (n=98) included children in the age range of 2–7 years. Outcomes for children 0-36 months old were not reported separately.
Outcomes Achieved
Child Outcomes
Parent Outcomes
A significant interaction and a main effect for time were observed for reducing parents’ tendencies to blame and attribute mal-intent to their children both in ambiguous and intentional situations (Sanders et al. 2004].
Significantly greater reduction in potential for child abuse and unrealistic parental expectations (Sanders et al. 2004).
Key References
Sanders, M.R., Pidgeon, A.M., Gravestock, F., Connors, M.D., Brown, S. & Young, S.W. (2004). Does Parental Attributional Retraining and Anger Management Enhance the Effects of the Triple P – Positive Parenting Program with Parents at Risk of Child Maltreatment. Behavior Therapy, 35, pp. 513-535.
Preschool: 3 to 5 years - Rating: 4+
Research Design & Number of Studies
The best evidence for children aged between 3-5 years old comes from three Randomised Controlled Trials (RCT), two conducted internally by the programme developer and one externally. In the first study, children (n=119) between 5 to 11 years old were included (Lanier et al. 2018), the second study included families (n=98) with children aged between 2 to 7 years (Sanders et al. 2004) and the third study included children (n=60) aged between 4–to 10 years (Wiggins et al. 2009).
Outcomes Achieved
Child Outcomes
Children in families assigned to the intervention group had a significant improvement after the intervention compared with families receiving usual services across four domains: physical functioning, emotional functioning, social functioning, and school functioning (Lanier et al. 2018).
Significantly greater reduction of child externalizing behaviour problems (parent reported) for the intervention group than for the control group (Wiggins et al. 2009).
Significant intervention effects were found for improving parent-child relationships and reducing behaviour problems with gains maintained at three-month follow-up compared to the wait list control group (Wiggins et al. 2009).
Parent Outcomes
Significantly greater increase in parent-child relationship quality including parent-child attachment, parenting confidence and involvement with a greater reduction in the use of dysfunctional parenting practices including laxness, verbosity and over-reactivity, blameworthy and intentional attributes for child behaviour from pre- to post intervention compared to parents in the control group, maintained at three-month follow-up (Wiggins et al. 2009).
Significantly greater reduction in potential for child abuse and unrealistic expectations maintained at six-month follow-up compared to the control group (Sanders et al. 2004).
Key References
Lanier, P., Dunnigan, A., & Kohl, P. L. (2018). Impact of Pathways Triple P on Pediatric Health-Related Quality of Life in Maltreated Children. Journal of Developmental and Behavioral Pediatrics , 39 (9), pp. 701-708.
Sanders, M.R., Pidgeon,A., Gravestock, F., Connors, M.D., Brown, S., & Young, R.W. (2004). Does parental attributional retraining and anger management enhance the effects of the triple P-positive parenting program with parents at risk of child maltreatment? Behavior Thera py, 35(3), 513–535.
Wiggins, T.L., Sofronoff, K. & Sanders, M.R. (2009). Pathways Triple P-Positive Parenting Program: Effects on Parent-Child Relationships and Child Behavior Problems. Fam Proc, 48, pp.517-530.
Primary school: 6 to 12 years - Rating: 4+
Research Design & Number of Studies
The best evidence for children in the 6-12 age range is the same as for the 3-5 age range above. Separate data for children 6-12-years old was not reported separately.
Adolescents: 13 to 18 years - Rating: 1+
Research Design & Number of Studies
Evidence for adolescents between the ages of 13-18 years was not available.
Need
Comparable Population
Pathways Triple P is aimed at parents with children aged up to 16 years who have difficulty regulating their emotions and at risk of physically or emotionally harming their children.
Evidence of its effectiveness includes families in Australia and the United States (urban and primary suburban counties) receiving child welfare services with children aged between 4 and 11 years.
Is this comparable to the population you serve?
Desired Outcome
Pathways Triple P is an individual or group intervention that aims to improve children’s mental health and well-being, prevent maltreatment and promote positive family relationships.
Research has identified that parents participating in Pathways Triple P demonstrated improvements in four child domains, including: physical functioning, emotional functioning, social functioning, and school functioning. Other favourable outcomes include improvements in parent-child relationship quality (including parent-child attachment), parenting confidence and involvement, with a reduction in the use of dysfunctional parenting practices including laxness, verbosity and over-reactivity, and blameworthy and intentional attributes for child behaviour. In addition, a significant reduction in the potential for child abuse and unrealistic expectations was also identified.
Is improving children’s mental health and well-being, improving parenting practices and problem behaviours and reducing the potential for child abuse an aim of your service?
Need Score
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Fit
Values
Triple P interventions aim to promote positive caring relationships between parents and their children. Pathways Triple P aims to support parents who have difficulty regulating their emotions and as a result are considered at risk of physically or emotionally harming their children, putting them at risk of abuse and neglect. It aims to enable parents to develop appropriate expectations of their child’s behaviour, develop anger management techniques, and learn positive parenting skills.
Is working with families who are considered at risk of neglecting their child or physically or emotionally harming them a priority for your organisation?
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.
Does taking a minimal sufficiency approach to offering support align with your service values?
Priorities
Pathways Triple P has been developed as an adjunctive intensive targeted intervention strategy within a preventative framework for parents of children up to 16 years to reduce the risk of child physical and emotional abuse and neglect from parents that have difficulty regulating their emotions.
Is taking an early intensive intervention and prevention approach to families who are at risk of child abuse and neglect a priority for your organisation?
Existing Initiatives
Pathways Triple P can be offered to families as an adjunct to level 3 Primary Care Triple P, Primary Care Stepping Stones Triple P, Primary Care Teen Triple P, or any level 4 Triple P programmes. Attendance at one of these programmes is a pre-requisite for parents to participate in Pathways Triple P.
Does your service already provide early intervention programmes aiming to reduce the risk of child physical and emotional abuse and neglect? Are Triple P level 4 programmes available within your service, or accessible for families within the local area?
Fit Score
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Capacity
Workforce
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 to deliver the intervention with families.
Triple P UK recommends that in addition to the session time (two to five 2-hour sessions), that practitioners have time for questionnaire scoring and feedback (2 hours), session preparation and supervision (4 hours), and case notes and report writing (4 hours). These time estimates are based on a group delivery with eight families participating in all modules, times will vary for individual delivery or changes in group size (groups can be delivered with up to eight families). Practitioners require time to attend training and accreditation which is estimated to take 4½ days, and must have completed a level 3 Primary Care Triple P, Primary Care Stepping Stones Triple P, Primary Care Teen Triple P Course, or a level 4 Triple P training course prior to attendance.
Do you have appropriate staff available to train? Do you have staff able to commit time to training and delivery of the intervention?
Technology Support
To implement Pathways 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 needed 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 Pathways 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, 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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