Stepping Stones Triple P parenting program

Stepping Stones Triple P is facilitated by accredited practitioners.

Cerebral Palsy Alliance also offers a service helping families and carers manage the challenging behaviours of their children.

Find a Cerebral Palsy Alliance service

Fees may apply to attend Stepping Stones Triple P programs and will depend on the service provider and the number of sessions needed.

Ask the service provider if you are eligible for funding to assist with fees. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

The time required depends on the type of program parents attend. More information on the types of programs offered is given below.

Stepping Stones Triple P was created for parents of children from 2 to 12 years of age and aims to:

• Help parents to independently solve their child’s problem behaviours as they occur
• Increase parents’ confidence and personal coping skills
• Reduce parenting stress
• Improve communication between parents and caregivers
• Support families to adapt to having a child with a disability
• Promote family and community participation.

The program is available in different formats, depending on family preferences and the level of support families require. The different formats include:

• Parent seminars
• Group programs with other parents of children with disability
• Individual consultation with a practitioner to manage common behaviour difficulties
• Intensive individually tailored programs for families and children with complex difficulties⁴.

The time required depends on the type of program parents attend. Group programs for instance, may run over six weeks, for 2-2.5 hours per week. Seminar formats may involve three lots of two hour seminars. Individually tailored programs may require shorter or longer periods of time depending on the needs of the parents and child. Time must also be put aside to complete homework tasks and practice strategies at home.

Each family’s goals are determined during the sessions. These usually centre on managing problem behaviours better or teaching the child new skills. Homework aimed at achieving the family’s goals is completed between each session. Stepping Stones Triple P is likely to be more effective if families have the time and resources to complete the homework and practice the strategies between sessions.

Attendance by both parents is recommended so that both can learn the strategies that will be used at home. When this is not possible, families are encouraged to participate in Stepping Stones Triple P as best they can. The parent who is unable to attend regularly can read through the workbook or tip sheets given out during sessions, attend sessions when possible or request telephone support from the course leader. When deciding on the best program format to suit each family, consider the time availability of both parents and the need for appropriate childcare.

• Language support – families from culturally and linguistically diverse backgrounds may be able to access interpreter services or attend a language-specific program
• One-on-one support – individual sessions with a practitioner focused on specific behavioural issues or teaching new skills can help families unable to commit to a full program or participate in group sessions
• Take-home support – a workbook is generally provided to assist with learning and practicing the strategies taught at the sessions. It is a valuable resource for other caregivers such as grandparents, along with any parents who can’t attend.
• A DVD is available for loan to families who may find it difficult to attend all sessions.

Practitioners will interview a family before they attend Stepping Stones Triple P to talk about the concerning behaviours, establish the reasons for attending and identify what they would like to achieve. The practitioner may also ask the family to complete questionnaires about their child’s behaviour and emotions, parent confidence and parenting style.

After completing the course, the practitioner may ask a family to complete the questionnaires again, to identify any changes. They may interview the family to find out if their goals were achieved.

We searched the psychology, allied health and medical literature to find research evaluating the outcomes of Stepping Stones Triple P for children with cerebral palsy and their families.

The search aimed to identify the best available evidence for whether this intervention improves a range of child and family factors including child behaviour, parenting skills and family stress.

Five articles (two from the same study) comprised the best available research about Stepping Stones Triple P. One was a systematic review⁵ which included two randomised controlled trials (RCTs) of Stepping Stones Triple P completed by families of children with disabilities. The additional four articles (describing three RCTs) have been published since the systematic review^6-8. One of these RCTs included families of children with Autism Spectrum Disorder and Down syndrome, but few children with cerebral palsy⁶. The second study examined Stepping Stones Triple P combined with Acceptance and Commitment Therapy^7-8 completed by families of children with cerebral palsy. Acceptance and Commitment Therapy is a behavioural approach that emphasises mindfulness, acceptance of your own thoughts and feelings, and living a life that aligns with your personal values. Results reported in each of these articles supported the effectiveness of Stepping Stones Triple P for children with disabilities when compared with no intervention. On the basis of these studies, Stepping Stones Triple P has a small positive impact on behaviour and emotional symptoms of children with cerebral palsy, as well as a positive impact on parents’ depression, stress and parenting style. The effects of Stepping Stones Triple P may be enhanced by the addition of Acceptance and Commitment Therapy for some outcomes.

The final article, however, reported different results. This RCT⁹ compared the outcomes of children with borderline to mild intellectual disability whose family was randomised to participate in Stepping Stones Triple P compared with families who received usual care. Immediately after the intervention, parenting stress was reduced in the group who attended Stepping Stones Triple P compared with the usual care group. There was no difference between Stepping Stones Triple P and usual care immediately after intervention or at the 6 months follow up for all other child and parent outcomes. Although this was a large RCT which had several methodological strengths including use of objective outcome measures and a longer term follow up, it also had a number of limitations which must be considered when interpreting the results. Families only needed to attend a minimum of 5 sessions to have been considered to complete intervention. This seems few sessions, considering the recommended program was 10 sessions. Only 51% of families completed five or more sessions (31% did not attend any sessions at all) and, although information on average number attended was not provided, it is possible that sufficient sessions were not attended to make a meaningful difference to child and family outcomes. In addition, children and families were not referred to the study for behaviour support, rather, large numbers of children were screened and invited to be part of the research based on questionnaire findings. Children who participated in the study were assessed, on average, as being in the milder range for behaviours of concern. They may not have had substantial room for improvement in behaviour outcomes. In addition, families may not have considered it a priority to implement behaviour management strategies at home or to attend the parenting program. Finally, 37% of the usual care group attended parenting support which may have diluted any results achieved by the Stepping Stones Triple P group.

Overall, the evidence is high level (from RCTs) and of moderate to good quality. With the exception of the latter study⁹, the results support the effectiveness of Stepping Stones Triple P for children with disabilities. However, only one of the studies^7-8 was specific to cerebral palsy. Taken together, these studies provide low to moderate quality evidence that Stepping Stones Triple P and Stepping Stones Triple P combined with Acceptance and Commitment Therapy, when compared with no intervention, have a small positive impact on behaviour and emotional symptoms of children with cerebral palsy, as well as a positive impact on parenting style, depression and stress.

The research evidence is an important piece of information to use when deciding whether Stepping Stones Triple P is right for a child and their family. The decision to be involved with Stepping Stones Triple P will also be based on family needs and preferences, the child’s behaviours of concern, and the availability and expertise of practitioners trained to deliver the program.