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Group Stepping Stones Triple P

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Evidence rating: 3+
Cost rating: 1

Stepping Stones Triple P has been developed for parents or caregivers of children aged 0 to 12 with a developmental disability, such as Down’s Syndrome or Autistic Spectrum Disorder. Group Stepping Stones Triple P is one mode of implementation of the Stepping Stones programmes.

It is delivered to groups of parents or caregivers with children who have mild to moderate level challenging behaviours. It is classified as a ‘Level 4’ Triple P programme. Parents learn skills and strategies to encourage their child’s social and communication skills, emotional self-regulation, independence and problem-solving ability. Practitioners use a range of learning methods with parents, including behavioural rehearsal to teach skills, guided participation to discuss assessment findings, active skills training methods to facilitate the acquisition of new parenting routines and generalisation-enhancement strategies to promote parental autonomy. Practitioners provide parents with constructive feedback on their implementation of the strategies. Parents also complete an activity workbook and undertake homework tasks.

EIF Programme Assessment

Evidence rating: 3+
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome. This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
Cost rating: 1
A rating of 1 indicates that a programme has a low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of less than €125. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Preventing crime, violence and antisocial behaviour

Reduced number of disruptive behaviours

based on study 1

  • Statement: 5.75-point reduction on the Eyberg Child Behavior Inventory (problem subscale - parent report)
  • Score: 34
  • Timeframe: Immediately after the intervention

Reduced frequency of disruptive behaviours

based on study 1

  • Statement: 22.34-point reduction on the Eyberg Child Behavior Inventory (intensity subscale - parent report)
  • Score: 35
  • Timeframe: Immediately after the intervention

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Preschool Primary school

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Group

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Primary school
  • Community centre

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted indicated

Where has it been implemented?

  • Australia
  • Canada
  • Denmark
  • England
  • Germany
  • Hong Kong
  • Ireland
  • Japan
  • New Zealand
  • Scotland
  • Singapore
  • Switzerland
  • United States

Ireland provision

This programme has been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

Group Stepping Stones Triple P is delivered in six group sessions of 2–2.5 hours’ duration and three individual telephone sessions of 30 minutes’ duration. It is delivered by one practitioner and 5–10 families attend the group sessions.


What happens during the intervention?

  • Sessions 1 and 2 focus on positive parenting, setting goals and promoting child development.
  • In the following sessions, parents are taught new skills, behaviours and strategies to teach children with disabilities and manage misbehaviour. They learn how to adapt strategies to suit their family’s needs.
  • The latter sessions focus on planning ahead, implementing parenting routines and looking at ways to maintain changes.
  • Parents will see examples of positive parenting on DVDs and will discuss what they have learned with the provider and group.
  • Parents also have a workbook to help record their goals and achievements.

What are the implementation requirements?

Who can deliver it?

The practitioner who delivers this programme may come from a range of backgrounds, including nursing, psychology and school counselling, with a recommended NFQ level of 6.


What are the training requirements?

The have 4.5 days of programme training / pre-accreditation session. Booster training of practitioners is not required.


How are the practitioners supervised?

It is recommended that practitioners are supervised by one host agency supervisor (qualified to NFQ-9/10 level). The host agency supervisor does not receive training.


What are the systems for maintaining fidelity?

  • Training manual
  • Other printed material
  • Other online material
  • Video or DVD training
  • Face-to-face training
  • Fidelity monitoring,

A quality assurance checklist is available for organisations to use when planning for quality assurance of Triple P. There are three standard fidelity protocols built into the Triple P Implementation Framework: (1) Practitioner Accreditation, (2) Intervention Fidelity using Session Checklists, (3) Supervision and Practitioner Support Standards using the Peer Support Network. Triple P UK offers trainer facilitated PASS sessions or a Flexibility & Fidelity workshop for professional development.


Is there a licensing requirement?

There is no licence required to run this programme.


How does it work? (Theory of Change)

How does it work?

  • Stepping Stones Triple P assumes that parents with a disabled child need help understanding and adapting to their child’s needs.
  • Parents therefore learn positive strategies for managing their child’s behaviour and helping their child become more independent.
  • Children, in turn, become more independent and learn how to better manage their own behaviour.
  • Children ultimately become more independent of their parents and parents experience less stress and greater family harmony.

Intended outcomes

  • Active and healthy, physical and mental wellbeing
  • Safe and protected from harm
  • Safe and protected from harm

Contact details

Matt Buttery
Triple P UK
matt.buttery@triplep.net

http://www.triplep.net/ 


About the evidence

Group Stepping Stones Triple P’s most rigorous evidence comes from an RCT which was conducted in Australia. This study identified statistically significant positive impact on a number of child and parent outcomes. This programme is underpinned by one rigorously conducted (level 3) study, hence the programme receives a Level 3 rating overall.

Study 1

Citation:Roux, G., Sofronoff, K., & Sanders, M. (2013)
Design:RCT
Country:Australia
Sample:52 families, with children between 2 and 9 years old
Timing:Post-test
Child outcomes:
  • Reduced number of disruptive behaviours
  • Reduced frequency of disruptive behaviours
Other outcomes:
  • Improved parenting style (parent self-report)
  • Improved parenting adjustment (parent self-report)
  • Reduced conflict over parenting (parent self-report)
Study rating:3

Roux, G., Sofronoff, K., & Sanders, M. (2013). A Randomized Controlled Trial of Group Stepping Stones Triple P: A Mixed-Disability Trial. Family Process, 52(3), 411–424.

Available at
http://onlinelibrary.wiley.com/doi/10.1111/famp.12016/full 

Study design and sample

This study is a rigorously conducted RCT. This study involved random assignment of parents to a Group Stepping Stones Triple P treatment group and a waitlist control group.

This study was conducted in Australia with a sample of 52 families with children between the ages of 2 and 9, with a mean age 4.8 years. Children had autistic spectrum disorder (with and without intellectual disability), Down syndrome, Cerebral Palsy, or an intellectual disability (global intellectual impairment or intellectual impairment not otherwise specified). Children either had, or were at risk of developing, behavioural problems. The majority of children were in 2-parent, original families.

Measures

Child and parent outcomes were measured on a number of scales: child behaviour and adjustment was measured using the Eyberg Child Behavior Inventory (problem and intensity scales) (parent-report). Child behavioural and emotional problems were measured using the Developmental Behavioural Checklist (parent-report). Parenting style was measured using the Parenting Scale (laxness, over-reactivity and verbosity scales) (parent self-report). Interparental conflict over child rearing was measured using the Parent Problem Checklist (parent self-report). Parenting adjustment was measured using the Depression Anxiety Stress Scales (parent self-report). Relationship quality and satisfaction was measured using the Relationship Quality Index (parent self-report).

Findings

This study identified statistically significant positive impact on a number of child and parent outcomes. The identified child outcomes were: improved child behaviour and adjustment (problem and intensity). Identified parent outcomes were: improved parenting style, improved parenting adjustment and reduced conflict over parenting.

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