Fear-Less Triple P
Fear-less Triple P (FLTP) is a parenting programme. It is a targeted indicated programme for children between the ages of six and 14 who are anxious. It is delivered to groups of families (up to eight) but can be delivered individually. It aims to support parents to replace ineffective parenting strategies with more effective methods for managing their child’s anxiety.
FLTP aims to provide parents with psychoeducation about anxiety and how it works, (in terms of both being able to coach their children in cognitive behavioural anxiety management strategies and to respond to their children’s anxiety), thereby targeting parent-related risk factors (e.g., over-protection, excessive reassurance, and ‘rescuing’ behaviours), providing effective cognitive behavioural coping strategies for their child’s anxiety.
It is intended for parents/caregivers of children between the ages of 6 and 14 who have moderate to high levels of anxiety.
The programme includes guidance from practitioners, peer support via group discussions, as well as video examples and roleplaying of skills learned.
EIF Programme Assessment
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:
Supporting children's mental health and wellbeing
Higher percentage of children free of any anxiety diagnosis
based on study 1
Lower anxiety symptoms
based on study 1
Lower internalising problems
based on study 1
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:
Primary school Preadolescents Adolescents
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Individual
- Group
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
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
- Ireland
- New Zealand
- United Kingdom
- United States
Ireland provision
Ireland evaluation
About the programme
What happens during the delivery?
How is it delivered?
Fear-Less Triple can either be completed in six weekly sessions (1-1.5h each) or as an intensive (one-day) group workshop of three sessions delivered in two-hour blocks to individual families or groups of one to eight families. It is usually delivered by a team of two to six therapists.
What happens during the intervention?
Each session of FLTP includes guidance from practitioners, peer support via group discussions, as well as video examples and roleplaying of skills learned.
What are the implementation requirements?
Who can deliver it?
What are the training requirements?
The practitioners have the following programme training: 3x days of training, 1x pre-accreditation day, 4-6 hours of preparation for accreditation day, 0.5 day accreditation, and 2-3 hours peer support. Total time: 5.5 days
How are the practitioners supervised?
What are the systems for maintaining fidelity?
Programme fidelity is maintained through the following processes:
- Training manual
- 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.
TPUK offers trainer-facilitated PASS sessions or a Flexibility & Fidelity workshop for professional development.
Is there a licensing requirement?
There is a licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Providing parents with effective cognitive behavioural strategies for managing anxiety (such as promoting emotional resilience and effective emotion regulation; flexible and realistic thinking; and overcoming avoidance through exposure), that they are supported to then ‘coach’ their children to use and change parent-related risk factors (e.g., over-protection, excessive reassurance, and ‘rescuing’ behaviours), in relation to how parents respond to their children’s anxiety which supports children in managing their own anxiety effectively.
- The programme aims to provide parents with psychoeducation about anxiety and how it works, (in terms of both being able to coach their children in cognitive behavioural anxiety management strategies and to respond to their children’s anxiety), thereby targeting parent-related risk factors (e.g., over-protection, excessive reassurance, and ‘rescuing’ behaviours), providing effective cognitive behavioural coping strategies for their child’s anxiety.
- In the short term, parents replace ineffective parenting strategies with more effective methods for managing their child’s anxiety, by teaching parents new cognitive behavioural strategies for anxiety management, applying these themselves, and encouraging them to teach these strategies (including coaching children in developing a toolbox of strategies for managing anxiety), to all their children (including any siblings), the child’s anxiety symptoms are reduced.
- In the longer term, parents demonstrate increased confidence in their children’s ability to regulate their own emotions (anxiety and other emotions) as opposed to feeling the need to do this for their children, greater awareness of anxiety management techniques, and more confidence in their abilities to perform these strategies. Children (including siblings of target child) have a toolbox of anxiety management strategies and demonstrate significant reductions in the severity of their anxiety symptoms, as well as reductions in functional impairments and emotional problems which improves family health and functioning and can affect the future life chances of children – including across their health, educational attainment, and social performance.
Intended outcomes
- Active and healthy, physical and mental wellbeing
Contact details
About the evidence
Fear-less 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 outcomes.
This programme is underpinned by one study with a Level 3 rating, hence the programme receives a Level 3 rating overall.
Study 1
| Citation: | Cobham et al., 2017 |
| Design: | RCT |
| Country: | Australia |
| Sample: | 61 families, with anxiety-disorder children between 7 and 14 years old (average age 9). |
| Timing: | Post-test 3-,6-,12-month follow-up |
| Child outcomes: |
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| Other outcomes: | |
| Study rating: | 3 |
Cobham, V. E., Filus, A., & Sanders, M. R. (2017). Working with parents to treat anxiety-disordered children: A proof of concept RCT evaluating Fear-less Triple P. Behaviour research and therapy, 95, 128-138.
Study design and sample
The first study is a rigorously conducted RCT.
This study involved random assignment of children to a Fear-less Triple P treatment group and a wait-list control group.
This study was conducted in Australia, with a sample of children with anxiety-disorder, aged between 7 and 14 (average age 9). The majority of the children were White (90%).
Measures
- Anxiety diagnosis was measured using the Anxiety Disorders Interview Schedule for Children (diagnostic interview)
- Anxiety symptoms were measured using the Spence Children’s Anxiety Scale (parent report; child report)
- Internalising problems were measured using the Child Behaviour Checklist (parent report)
Findings
This study identified statistically significant positive impact on a number of child outcomes.
This includes:
- Higher percentage of children free of any anxiety diagnosis
- Lower anxiety symptoms
- Lower internalising problems