ORGANIZATION INFORMATIONThis form should be completed by the individual who will serve as the point of contact for your agency regarding Triple P. As one of the individuals responsible for the implementation of Triple P, the information you provide through this brief form will assist in effective planning and selection of practitioners. Please do not hesitate to contact the Mecklenburg County Triple P Coordinators for questions or additional support with completing this form.

980-314-9128 or triplep@mecklenburgcountync.gov

Organization Information

Organization Name:

Organization Address:

Agency Phone: Agency Website

CEO/President Name:

CEO/President Email:

Number of years the organization has been serving the community in which you will deliver Triple P:

Name of individual responsible for over site of Triple P Implementation:

Position Title:

Phone: cell / office cell / office

Email: Best way to contact you: Email / Phone

1) Please estimate the number of unduplicated parents that your agency reaches per year. ____________

2) How do staff within your agency typically work with families?

Individual (child/adolec. therapy) ____ Individual (adult therapy) ____%

Groups ____% Intensive consultations ____%

Brief face-to-face consultations ____% Telephone Consultations ____%

Other: ____________________ ____%

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Triple P Mecklenburg ClusterOrganization Training Interest Form

Today’s Date:

3) What is the most common child’s age range you experience through your work with parents (i.e. parents of children 0 to 12 years; parents of teenagers; and/or parents of children with a disability)? For example: “I work with 100 parents per year. About 35 (35%) of these parents have children under 5, 50 (50%) have children ages 5-12, and 15 (15%) have children ages 13-18.” Note: the quantity you identify here will be used as a guide to determine your individual goal of families reached.

4) Which behavioral issues do you typically see (common or more advanced issues, i.e. parents at risk of maltreating their children, children with mild behavioral problems)?

Desired Outcomes

What are the outcomes and goals the organization wants to achieve by providing Triple P? (These may have been defined within a funding proposal or may be specific to the organization)

Examples:

Reduction in substantiated child abuse cases* Improvement in children’s social, emotional, and behavioral health Increases in positive parenting practices Reduction in parenting stress

*Note: this outcome relates to a comprehensive approach

How does Triple P fit with the current mission of your organization?

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Triple P Service Deliverables

As an organization, how many parents do you hope to impact through Triple P?

Is your organization prepared to support and enforce practitioner collection of county required client assessments and outcome data for parents served with Triple P?

Yes No

Which levels of Triple P are you interested in adding to your menu of services (see description on next page)

0-12 Years Teen Stepping Stones Adjunctive Support

☐ Selected Seminars☐ Primary Care☐ Discussion Groups☐ Group☐ Standard

☐ Selected Seminars Teen

☐ Primary Care Teen☐ Group Teen☐ Standard Teen

☐ Primary Care Stepping Stones

☐ Group Stepping Stones☐ Standard Stepping

Stones

☐ Enhanced☐ Pathways☐ Family

Transitions☐ Lifestyle

How many providers would you need trained in each level of Triple P to reach your parent goal stated above?

Enter the number in the box right of each course.

Selected Seminar

Primary Care

Discussion Groups

Group

Standard

Selected Seminars Teen

Primary Care Teen

Group Teen

Standard Teen

Primary Care Stepping Stones

Group Stepping Stones

Standard Stepping Stones

Enhanced

Pathways

Family Transitions

Lifestyle

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Triple P Provider Training Options** The County Triple P Initiative may not offer trainings in all modules but will provide information

and contact for Triple P America for additional organizational or individual interest

Brief Primary Care Triple P Training Course is relevant to practitioners who regularly offer advice and support to parents with children (aged 0 to 16 years) during brief opportunistic consultations. Using this model, practitioners have a brief consultation (15 to 30 minutes) with families plus a follow-up visit or phone call to review if required.

Primary Care Triple P Training Course is relevant to practitioners who regularly offer advice and support to parents with children and teens (aged 0 to 16 years) during focused consultations carried out in the course of providing routine health surveillance and care. Using this model, practitioners have 3 to 6 consultations (15 to 45 minutes) with families over a 4 to 6 week period.

Selected (Seminars) Triple P Provider Training Course teaches Triple P Providers the skills to conduct parenting information seminars for parents with children and teens (aged 0 to 16 years). Selected Triple P is suitable as a universal prevention strategy where it is offered to parents entering an intervention or school age service. Primary Care, Standard or Group is a pre-requisite for this course.

Discussion Group Triple P Training Course is relevant to practitioners who are able to provide 2 hour small group (6-10 parents) sessions focused on commonly encountered problems. Topics for 0-12 year olds include disobedience, bedtime routines, and fighting and aggression. Topics for teens include getting teens to cooperate, coping with emotions and reducing family conflict. Primary Care training is a pre-requisite for this course.

Standard Triple P Training Course is relevant to practitioners who have appropriate qualifications and the capacity to deliver intensive interventions (10 x I hour sessions) that focus on parent-child interactions, the application of parenting skills to a broad range of target behaviors, and the use of generalization-enhancement strategies to promote parental autonomy.

Group Triple P Training Course is relevant to practitioners who have appropriate qualifications and the capacity to deliver group training (5 x 2 hours sessions plus 3 x individual sessions) that focus on general parenting skills i n application to a broad range of target behaviors, and the use of generalization-enhancement strategies to promote parental autonomy.

Stepping Stones Triple P Provider Training Course is an early intervention strategy for families of children with disabilities who currently have or are at risk of developing behavioral and emotional disorders. It is particularly useful for families who also have difficulty adjusting to their child's disability. This professional training course provides participants with a rationale and background information to conduct behavioral intervention in families of children who have a disability.

Level 5 (Enhanced, Pathways, Lifestyles and Family Transitions) Triple P Training Courses are enhanced behavioral family intervention programs with additional modules for families where parenting difficulties are complicated by other sources of family distress (e.g., marital conflict, parental depression, anger management problems or high levels of stress). In most cases, Level 4 is a pre-requisite for Level 5 both in practitioner training and parent delivery.

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Implementation Considerations

What do you see as your organization’s greatest assets in implementing Triple P?

What do you foresee as concerns or challenges with implementing Triple P through your organization or community? Please describe.

What might be helpful to your organization to effectively implement Triple P? Please describe.

Is your agency prepared to assume fiscal responsibility for the purchase of Triple P materials required to implement and sustain the use of Triple P for the level(s) at which your selected staff is trained? Please describe.

Thank you for completing this questionnaire. The information you have provided will be of value to both you and your staff in the implementation of Triple P in your organization. Please return completed form to Triple P Coordinators at triplep@mecklenburgcountync.gov.

Triple P | Positive Parenting Program