What is Triple P • Aims of Triple P • The Triple P Model • Levels of Intervention

LEVELS OF INTERVENTION IN THE TRIPLE P SYSTEM

Level 1 Universal Triple P

This level of intervention involves using health promotion and social marketing strategies to make available to parents information about how they can promote their child’s development and deal with commonly encountered behavior issues, many of which are best viewed as part of normal development. Information may be accessed through a community-wide media strategy that includes the use of television, print and other electronic media to increase community awareness, acceptance and support for the importance of parenting. The aim of this level of intervention is to facilitate parents' access to information about how to deal with common child-rearing issues.

 

The media has the potential to reach far greater segments of the population at any one time than other forms of community outreach and can be used to increase the visibility of parenting messages. Media campaigns can be developed for national, state or local community access. The media strategy can support other levels of intervention to send optimistic yet realistic messages to the community about the importance of parenting; depict realistic solutions to commonly encountered problems; and suggest where families can go for further help. This strategy serves to normalize and de-stigmatize parenting difficulties and prompt parents to seek help, information or advice on children’s behavior if they need it.

 
Level 2 Selected Triple P  

The media-based parenting information campaign can be supported by providing information to parents through primary care services and other community agencies in regular contact with families of young children. Primary care services refer to those services and programs that have wide reach in the community and are therefore readily accessible to parents. They traditionally include maternal and child health services, family doctors, childcare centers, preschools, kindergartens, schools and other community agencies that offer parent support. These services are well positioned to provide preventively oriented parenting programs because parents use them frequently, see them as credible sources of information about children, and do not associate them with the stigma often attached to seeking specialist mental health services.

 

The Level 2 parenting information and support strategy involves primary care professionals in regular contact with families having periodic discussions with parents about developmental and behavioral issues, and providing parents with information about how to cope with specific child-rearing issues. Parenting tip sheets and videos can be used as part of anticipatory developmental guidance provided by the practitioner. Each tip sheet suggests effective ways of preventing or solving a common child management or developmental problem and typically includes information about the problem, why the problem may develop, how to prevent the problem, how to manage or solve the problem, and where to go for further help if required. Agencies display available resource material to prompt parents to request information from their practitioner. Information is provided within a brief consultation format (one or two 10-minute sessions) that clarifies the presenting problem, explains the materials and tailors the information to the family’s needs. Families are invited to return for further help if they have any difficulties.

 
Level 3 Primary Care Triple P

Level 3 intervention, a primary care strategy, incorporates brief behavioral counseling as an early detection and brief intervention approach to managing identified problems. This level of intervention involves four 15-30 minute consultations with parents. Practical advice on managing a specific problem behavior is provided, assisted by selective use of parenting tip sheets and video resources. Level 3 interventions may also incorporate active skills training procedures such as behavioral rehearsal. This involves modeling and then coaching parents in the implementation of specific parenting strategies or routines using rehearsal, constructive feedback and goal setting. In the first session the history and nature of the presenting problem are clarified (through interview and direct observation), goals for the intervention negotiated and a baseline monitoring system set up to track the occurrence of problem behavior. Session 2 involves discussing the results of the baseline monitoring, sharing conclusions about the nature of the problem (i.e. the diagnostic formulation) and its possible etiology; and negotiating a parenting plan (using a tip sheet or designing a planned activities routine). This plan may involve the introduction of specific positive parenting strategies through discussion, modeling or presentation of segments from the Every Parent’s Survival Guide video. This session also involves identifying and countering any obstacles to implementation of the new routine by developing a personal coping plan with each parent. The parents then implement the program. Session 3 involves monitoring the family’s progress and discussing any implementation problems, it may also involve introduction of additional parenting strategies and more intensive active skills training exercises. The aim is to refine the parents’ implementation of the routine as required and provide encouragement for their efforts. Session 4 involves a progress review, trouble shooting for any difficulties the parents may be experiencing, positive feedback and encouragement, and termination of contact.

 

Level 4 Standard Triple P / Group Triple P / Self-Directed Triple P

As in Level 3, this level of intervention combines the provision of information with active skills training and support. However, it teaches parents to apply parenting skills to a broad range of target behaviors in both home and community settings with the target child and siblings. There are several different delivery formats available at this level of intervention.

Standard Triple P

This 10-session program incorporates sessions on causes of children’s behavior problems, strategies for encouraging children’s development and strategies for managing misbehavior. Active skills training methods used in the sessions include modeling, rehearsal, self-evaluation, and homework tasks. Segments from Every Parent’s Survival Guide [video] may be used to demonstrate positive parenting skills. Several generalization enhancement strategies are incorporated into the program (e.g. training with sufficient exemplars, training loosely) to promote the transfer of parenting skills across settings, siblings and time. Home or clinic practice sessions are also conducted in which parents self-select goals to practice, are observed interacting with their child and implementing parenting skills, and subsequently self-evaluate their progress toward meeting their goals. Further sessions cover identifying high-risk situations and developing planned activities routines. Finally, maintenance and relapse issues are discussed. Sessions last about 60 minutes each (with the exception of practice sessions which should last about 40 minutes each).

Group Triple P

Group Triple P is an 8-session program, ideally conducted in groups of 10—12 parents. It employs an active skills training process to help parents acquire new knowledge and skills. The program consists of four 2-hour group sessions which provide opportunities for parents to learn through observation, discussion, practice and feedback. Segments from the Every Parent’s Survival Guide video are used to demonstrate positive parenting skills. These skills are then practiced in small groups. Parents receive constructive feedback about their use of skills in an emotionally supportive context. Between sessions, parents complete homework tasks to consolidate their learning from the group sessions. Following the group sessions, four 15-30 minute follow-up telephone sessions provide additional support to parents as they put into practice what they have learned in the group sessions. Although delivery of the program in a group setting may mean parents receive less individual attention, there are several benefits of group participation for parents. These benefits include support, friendship and constructive feedback from other parents as well as opportunities for parents to normalize their parenting experience through peer interactions.  

 

Self-Directed Triple P

In this self-directed delivery mode, detailed information is provided in a parenting workbook, Every Parent's Self-Help Workbook which outlines a 10-week self-help program for parents. Each weekly session contains a series of set readings and suggested homework tasks for parents to complete.

Some parents require and seek more support in managing their children than simply having access to information. Hence, the self-help program may be augmented by weekly 15-30 minute telephone consultations. This consultation model aims to provide brief, minimal support to parents as a means of keeping them focused and motivated while they work through the program and assists in tailoring the program to the specific needs of the family. Rather than introducing new strategies, these consultations direct parents to those sections of the written materials that may be appropriate to their current situation, as in the Group Triple P telephone sessions.

Level 5 Enhanced Triple P  

Following participation in a Level 4 program, families requesting or deemed to be in need of further assistance are invited to participate in this individually tailored program. This level extends the focus of intervention to include home-based skills training, mood management and stress coping skills for parents, and marital communication skills as required. The first session is a review and feedback session in which parents' progress is reviewed, goals are elicited and a treatment plan negotiated. Three enhanced individual therapy modules may then be offered to families individually or in combination: Practice, Coping Skills and Partner Support. Each module is ideally conducted in a maximum of three sessions lasting up to 90 minutes each (with the exception of practice sessions which should last 40 minutes each). Within each additional module, the components to be covered with each family are determined on the basis of clinical judgment and needs identified by the family (i.e. certain exercises may be omitted if parents have demonstrated competency in the target area). All sessions employ an active skills training process to help parents acquire new knowledge and skills. Parents are actively involved throughout the program with opportunities to learn through observation, discussion, practice and feedback. Between sessions, parents complete homework tasks to consolidate their learning. Following completion of the individually tailored modules, a final session is conducted which aims to promote maintenance of treatment gains by enhancing parents' self-management skills and thus reduce parents’ reliance on the clinician.

The Practice module typically consists of three sessions conducted in the family’s home. These sessions give parents opportunities to practice and receive personalized feedback on their application of the positive parenting strategies introduced in Level 4 Triple P. This process allows the parents and clinician to work together to identify and overcome obstacles and refine their implementation of these strategies. These sessions are largely self-directed, with parents setting their own goals, evaluating their own performance and setting their own homework tasks.

 

The Coping Skills module is designed for parents experiencing personal adjustment difficulties that interfere with their parenting ability. These difficulties may include depression, anxiety, anger or stress. The module typically consists of three sessions that help parents identify dysfunctional thinking patterns and introduces parents to personal coping skills such as relaxation, coping statements based on stress inoculation training (Meichenbaum, 1974), challenging unhelpful thoughts (Beck, Rush, Shaw, & Emery, 1979), and developing coping plans.

 

The Partner Support module is designed for two-parent families with relationship adjustment or communication difficulties. The module typically consists of three sessions that introduce parents to a variety of skills to enhance their teamwork as parenting partners. It helps partners improve their communication, increase consistency in their use of positive parenting strategies, and provide support for each other’s parenting efforts. Parents may be taught positive ways of listening and speaking to one another, sharing information and keeping up to date about family matters, supporting each other when problems occur, solving problems, and building a caring relationship as a couple.

ACCESS TO LEVELS OF INTERVENTION

When the full system is implemented, families can enter the Triple P system of intervention at any level. The multi-level model does not require a sequential progression from the least to most intensive level of intervention, although this is a common path. Some families may be referred immediately to Level 4 or 5 interventions and may then receive support to maintain intervention gains within the Level 2 or 3 brief consultation format as part of anticipatory well-child care with a general medical practitioner or other health professional, or through accessing further information resources (Level 1). Completion of one level of intervention does not preclude access to other services, and should in some cases be encouraged (e.g. completion of a Level 4 group program while on a waitlist for individual sessions may be cost effective and reduce the number of individual sessions subsequently required). At all points of contact, families are encouraged to re-contact if they are experiencing further difficulties.

What is Triple P • Aims of Triple P • The Triple P Model • Levels of Intervention

Contact information: Email: triplepa@bellsouth.net Telephone: (803) 787.9944 
Mailing Address: Triple P America • 4840 Forest Drive # 308 • Columbia, SC 29206