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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.
Triple P for Baby is a level 4 individual and group-based intervention. This level focuses on providing families with intensive training in positive parenting. Triple P for Baby is designed for parents in the transition to parenthood or with a baby up to 12 months of age. Triple P for Baby aims to increase positive parenting skills to promote secure attachment and reduce infant distress, improve partner and social support to increase overall family well-being, and increase parental coping resources to reduce the risk of mental health problems developing. Parents actively participate in a range of exercises to learn about baby development and behaviour, and common changes when their baby arrives, as well as strategies to help teach their baby new skills and behaviours.
Practitioners deliver an 8-session programme which involves four (2-hour) groups of up to 10 parents, and four (30-minute) individual (telephone) consultations to assist parents with independent problem solving while they are practising the skills at home. These sessions provide parents with a brief introduction to (1) Positive Parenting, (2) Responding to Your Baby, (3) Survival Skills, (4) Partner Support and (5) Implementing Parenting Routines. The programme can be delivered prenatally with the individual consultations delivered postnatally, or the entire programme can be delivered postnatally.
Triple P for Baby 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 Triple P for Baby Group 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.
Modifiable Components
Triple P practitioners can tailor interventions 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 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. Para-professionals are expected to have knowledge of child or adolescent development, and/or experience working with families.
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 training and accreditation. The total time to attend training and accreditation is estimated to take five days. This includes three days of training, one day for a pre-accreditation workshop, half a day for quiz and competency preparation and a half day for accreditation.
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) which includes and 2-3 hours of peer support per month. 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.
Antenatal / Perinatal: from conception to birth - Rating: 4
Research Design & Number of Studies
Evidence for Triple P for Baby in the antenatal/perinatal period includes one Randomised Control Trial (RCT). This study (McPherson, 2019) included first time parents in Glasgow in their antenatal period followed up in the postnatal period (n=156).
Outcomes Achieved
Child Outcomes
Parent Outcomes
Compared to the control group significantly lower levels of depression in mothers at post-intervention were reported (McPherson et al, 2019).
Compared to the control group significantly lower levels of anxiety in fathers at all time points were reported (McPherson et al, 2019).
Key References
McPherson, K.E., McAloney, K., & Wiseman, K. (2019). Triple P for Baby: A Randomized Controlled Trial Testing the Efficacy in First Time Parent Couples. Glasgow Caledonian University.
Infants and Toddlers: 0-36 months - Rating: 4
Research Design & Number of Studies
The best evidence for infants 0-36 months includes a Randomised Control Trial (RCT) which included families (n=323) with infants born <32 weeks in Australia (Colditz, 2019). In addition, the evidence presented above included parents of antenatal and perinatal infants and remains relevant for this age range.
Outcomes Achieved
In addition to the outcomes already stated:
Child Outcomes
Intervention group compared to care as usual group scored significantly higher on cognition and motor skill (Colditz et al, 2019).
Parent Outcomes
Key References
Colditz, P.B., Boyd, R.N., Winter, L., Pritchard, M., Gray, P.H., Wittingham, K., O’Callaghan, M., Jardine, L., O’Rourke, P,. Marquart, L., Forrest, K., Spry, C & Sanders, M. (2019). A Randomized Trial of Baby Triple P for Preterm Infants: Child Outcomes at 2 Years of Corrected Age. The Journal of Pediatrics. 210 pp. 48-54.
Need
Comparable Population
Triple P for Baby is for parents at the transition to parenthood or with a baby up to 12 months of age who wish to learn about baby development and behaviour, and common changes when their baby arrives, as well as strategies to help teach their baby new skills and behaviours.
Evidence has shown improvements in pre-term infants in Brisbane, Australia and improvements in first time parent couples recruited during the antenatal period and followed up in the postnatal period in Glasgow, Scotland.
Is this comparable to the population you serve?
Desired Outcome
Triple P for Baby is an individual and group-based intervention designed for parents during the prenatal or postnatal period at the transition to parenthood or with a baby up to 12 months of age. Triple P for Baby aims to increase positive parenting skills to promote secure attachment and reduce infant distress, improve partner and social support to increase overall family well-being, and increase parental coping resources to reduce the risk of mental health problems developing.
Research has shown improvements in cognition and motor skills in pre-term infants and significantly lower levels of depression in mothers at post-intervention and lower levels of anxiety in fathers at all time points.
Are the improvements of parenting practices and baby’s skills and behaviour a priority outcome for your organisation? Is supporting parents to develop skills to support baby development and also reducing parental stress a priority for your service? Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?
Need Score
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Fit
Values
Triple P interventions aim to promote positive caring relationships between parents and their infants/children/adolescents and to help parents develop positive parenting strategies. Triple P for Baby aims to increase positive parenting skills to promote secure attachment and reduce infant distress, improve partner and social support to increase overall family well-being, and increase parental coping resources to reduce the risk of mental health problems developing.
Does promoting positive playful relationship between parents and children to support early child development align with the key values of your service/organisation?
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.
Does taking a minimal sufficiency approach to offering support align with your service values? (10)
Priorities
The Triple P system has been developed as an early intervention strategy within a preventative framework. Triple P for Baby is designed for parents at the transition to parenthood or with a baby up to 12 months of age and aims to teach parents about positive parenting skills, improving partner and social support, and increasing parental coping resources. Triple P for Baby is suitable as a targeted intervention for specific groups (e.g. pre-term babies, mothers with mental health difficulties) and as a universal programme to help develop skills and strategies to support parents and infants in the early years.
Is taking an early intervention/prevention approach for parents to learn about baby development, behaviour and changes a priority for your service? Is developing teaching strategies for parents to help their baby a service priority for you?
Existing Initiatives
Does your service already provide early intervention programmes aiming to improve parents’ education and their ability to support their baby’s development? Are the existing initiatives effective? Do existing initiatives fit your current and anticipated future requirements?
Fit Score
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Capacity
Workforce
Triple P UK recommends that the practitioners have a post-high school qualification in health, education, childcare, or social services. One practitioner is required to deliver Triple P for Baby
Do you have appropriate staff to train and deliver this intervention? Does your organisation have administrative capacity and systems to meet the needs of a home based programme, including travel, documentation?
Triple P for Baby practitioners require time to attend training and for group delivery. Triple P recommends that in addition to the session time (four 2-hour group sessions, and four 30-minute individual consultations per family), that practitioners have time for session preparation and post-session debrief/supervision (4 hours per group), pre- and post-assessment questionnaire scoring and feedback (5 hours per group), and case notes and reporting writing (5 hours per group). These time estimates are based on a group delivery with ten families participating, times will vary for different group sizes.
Practitioners are required to attend training and accreditation. The total time to attend training and accreditation is estimated to take five days. This includes three days of training, one day for a pre-accreditation workshop, half a day for quiz and competency preparation and a half day for accreditation. In addition, participation in the peer support groups requires 2-3 hours per month however this is not a mandatory requirement.
Do you have staff with the capacity to train in, and deliver this intervention?
Technology Support
To implement Triple P for Baby, 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 needed to deliver the programme? Programme delivery can involve families viewing a DVD with the practitioner, do you have the technology available for practitioners to do this?
Administrative Support
Administrative support is required to collect evaluation data and feedback, print off materials along with coordinating and booking of venues.
Do your current administrative procedures support your practitioners to implement a programme like this including receiving referrals from a variety of agencies?
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 implementation of this programme?
Capacity Score
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